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Three-Dimensional Radiographic Analysis of Two Distinct Lenke 1A Curve Patterns

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Abstract

Study Design

Retrospective review of three-dimensional (3D) imaging from a multicenter database of surgically treated adolescent idiopathic scoliosis (AIS) patients.

Objective

To use 3D analysis software to compare Lenke 1AR and 1AL curves in the coronal, sagittal, and axial planes.

Background Data

The Lenke 1AR and AL curve patterns have been shown to be two distinct curve types, with 1AL curves being more likely to add on after fusion. Analysis in 3D may help define some of the intricacies of these two curves.

Methods

Ninety-four AIS patients with Lenke 1A curves and upright biplanar scanned radiographs were reviewed. Analysis was performed using 3D reconstruction software to evaluate the 3D coronal, sagittal and axial plane deformities. Coronal L4 tilt was used to distinguish between the two curve patterns.

Results

The main thoracic Cobb was not significantly different between the AR (n = 43) and AL (n = 51) curves (52° ± 8° vs. 50° ± 5°; p = .25). The thoracolumbar/lumbar Cobb was significantly smaller in the AR curves (28° ± 8° vs. 32° ± 7° ; p = .02). In the sagittal plane, T5–T12 kyphosis and T12–S1 lordosis were not significantly different (p > .2); however, the T10–L2 alignment was significantly more lordotic in the AR curves (11° ±8° vs. 4° ± 10° lordosis; p <.001). In the axial plane, thoracic apical rotation was significantly greater in AR curves (21° ±6° vs. 14° ± 6°; p < .001) and lumbar apical rotation was significantly smaller in AR curves (1° ± 5° vs. 6° ± 5°; p < .001).

Conclusion

3D spinal analysis demonstrates that 1AR and AL curves are distinctly different in all three planes. Although the treatment-based Lenke classification system combines these two curve patterns into one curve type, the 3D assessment suggests there are clear features that differentiate these curve patterns. The differing features of the nonstructural lumbar curves may help define the variance in fusion level selection and risk of adding-on for these two curve patterns.

Level of Evidence

Level II, prognostic.

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Author information

Authors and Affiliations

  1. Department of Orthopedics, Riley Children’s Hospital, Indianapolis, IN, USA

    Ryan Fitzgerald MD

  2. Department of Orthopedics, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92023, USA

    Vidyadhar V. Upasani MD, Burt Yaszay MD & Peter O. Newton MD

  3. Department of Orthopedics, Rady Children’s Hospital, 3020 Children’s Way, MC5062, San Diego, CA, 92123, USA

    Vidyadhar V. Upasani MD, Tracey P. Bastrom MA, Carrie E. Bartley MA, Fredrick G. Reighard MPH, Burt Yaszay MD & Peter O. Newton MD

Authors
  1. Ryan Fitzgerald MD
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  2. Vidyadhar V. Upasani MD
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  3. Tracey P. Bastrom MA
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  4. Carrie E. Bartley MA
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  5. Fredrick G. Reighard MPH
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  6. Burt Yaszay MD
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  7. Peter O. Newton MD
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Corresponding author

Correspondence to Vidyadhar V. Upasani MD.

Additional information

RF (none), VVU (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine and OrthoPediatrics, outside the submitted work), TPB (grants from Setting Scoliosis Straight Foundation to her institution, during the conduct of the study), CEB (grants from Setting Scoliosis Straight Foundation to her institution, during the conduct of the study), FGR (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), BY (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M and DePuy Synthes Spine; personal fees from NuVasive, Medtronic, Orthopediatrics, Stryker, and Globus; grants from Setting Scoliosis Straight Foundation, outside the submitted work; in addition, BY has a patent K2M with royalties paid), PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation; other from Rady Children’s Specialists; grants, personal fees, and nonfinancial support from DePuy Synthes Spine; grants and other from SRS; grants from EOS imaging; personal fees from Thieme Publishing; grants from NuVasive; other from Electrocore; personal fees from Cubist; other from International Pediatric Orthopedic Think Tank; grants, nonfinancial support and other from Orthopediatrics; grants, personal fees, and nonfinancial support from K2M; grants and nonfinancial support from Alphatech, outside the submitted work; in addition, PON has a patent “Anchoring Systems and Methods for Correcting Spinal Deformities” [8540754] with royalties paid to DePuy Synthes Spine, a patent “Low Profile Spinal Tethering Systems” [8123749] licensed to DePuy Spine, Inc., a patent “Screw Placement Guide” [7981117] licensed to DePuy Spine, Inc., a patent “Compressor for Use in Minimally Invasive Surgery” [7189244] licensed to DePuy Spine, Inc., and a patent “Posterior Spinal Fixation” pending to K2M).

IRB approval was in place at the time of this study.

This study was conducted at Rady Children’s Hospital, San Diego, CA.

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Fitzgerald, R., Upasani, V.V., Bastrom, T.P. et al. Three-Dimensional Radiographic Analysis of Two Distinct Lenke 1A Curve Patterns. Spine Deform 7, 66–70 (2019). https://doi.org/10.1016/j.jspd.2018.06.005

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  • DOI: https://doi.org/10.1016/j.jspd.2018.06.005

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