Skip to main content

Advertisement

SpringerLink
Log in

What Factors Are Associated With Kyphosis Restoration in Lordotic Adolescent Idiopathic Scoliosis Patients?

  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Review of a prospective adolescent idiopathic scoliosis (AIS) multicenter registry.

Objective

To evaluate predictors of surgical thoracic kyphosis restoration in AIS patients with lordotic preoperative thoracic sagittal profiles.

Summary of Background Data

Prior work on kyphosis-producing techniques has yielded mixed findings and has focused on the sagittal plane in 2D.

Methods

A validated formula to predict 3D T5–T12 sagittal alignment using standard 2D measures was applied in a cohort of 1614 Lenke 1–4 patients treated with posterior instrumentation using 5.5-mm-diameter rods. Patients with 3D kyphosis 1 standard deviation (12.2°) below the mean (5.3°) were identified as the study cohort. Predictors of 3D T5–T12 kyphosis at two years were evaluated using univariate analysis followed by Classification and Regression Tree (CART).

Results

There were 134 patients identified. All had preoperative 3D T5–T12 kyphosis of <−7°. The average 3D kyphosis was −13° ± 5° preoperatively and 20° ± 7° at two years (p < .001). The thoracic coronal curve improved from 62° ± 12° to 21° ± 8° at two years (p < .001). Of 15 variables analyzed, multivariate CART analysis identified only surgeon as a predictor of 2-year kyphosis. Two surgeon groups were identified by CART which included those who restored more kyphosis versus those who restored less. Subsequent analysis demonstrated significant differences between groups in the rate of Ponte osteotomies used (p < .023), stainless steel versus cobalt chromium rods (p < .001), and segmental screw fixation (p < .001).

Conclusion

Kyphosis restoration in patients with preoperative lordosis in the thoracic sagittal plane is possible. In this analysis, there was not one single technique identified as being solely responsible for the ability to restore kyphosis. The most predictive factor identified was the surgeon performing the correction, which is likely a reflection of focus on deformity correction in three planes, as well as a combination of methods used to restore kyphosis.

Level of Evidence

Level III, therapeutic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. de Jonge T, Dubousset JF, Illes T. Sagittal plane correction in idiopathic scoliosis. Spine (Phila Pa 1976) 2002;27:754–60.

    Article  Google Scholar 

  2. Moskowitz A, Moe JH, Winter RB, et al. Long-term follow-up of scoliosis fusion. J Bone Joint Surg Am 1980;62:364–76.

    Article  CAS  Google Scholar 

  3. Petcharaporn M, Pawelek J, Bastrom T, et al. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine (Phila Pa 1976) 2007;32:2226–31.

    Article  Google Scholar 

  4. Clement JL, Chau E, Kimkpe C, et al. Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine (Phila Pa 1976) 2008;33:1579–87.

    Article  Google Scholar 

  5. Sucato DJ, Agrawal S, O’Brien MF, et al. Restoration of thoracic kyphosis after operative treatment of adolescent idiopathic scoliosis: a multicenter comparison of three surgical approaches. Spine (Phila Pa 1976) 2008;33:2630–6.

    Article  Google Scholar 

  6. Karatoprak O, Unay K, Tezer M, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery. Int Orthop 2008;32:523–8; discussion 529.

    Article  Google Scholar 

  7. Sugarman E, Sarwahi V, Amaral T, et al. Comparative analysis of perioperative differences between hybrid versus pedicle screw instrumentation in adolescent idiopathic scoliosis. J Spinal Disord Tech 2013;26:161–6.

    Article  Google Scholar 

  8. Lowenstein JE, Matsumoto H, Vitale MG, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 2007;32:448–52.

    Article  Google Scholar 

  9. Suk SI, Lee CK, Kim WJ, et al. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 1995;20:1399–405.

    Article  CAS  Google Scholar 

  10. Watanabe K, Lenke LG, Bridwell KH, et al. Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees: wires versus hooks versus screws. Spine (Phila Pa 1976) 2008;33:1084–92.

    Article  Google Scholar 

  11. Vora V, Crawford A, Babekhir N, et al. A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine (Phila Pa 1976) 2007;32:1869–74.

    Article  Google Scholar 

  12. Schmidt C, Liljenqvist U, Lerner T, et al. Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation. Eur Spine J 2011;20:1118–26.

    Article  Google Scholar 

  13. Fletcher ND, Hopkins J, McClung A, et al. Residual thoracic hypo-kyphosis after posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications. Spine (Phila Pa 1976) 2012;37:200–6.

    Article  Google Scholar 

  14. Imrie M, Yaszay B, Bastrom TP, et al. Adolescent idiopathic scoliosis: should 100% correction be the goal? J Pediatr Orthop 2011;31:S9–13.

    Article  Google Scholar 

  15. Bernstein P, Hentschel S, Platzek I, et al. Thoracal flat back is a risk factor for lumbar disc degeneration after scoliosis surgery. Spine J 2014;14:925–32.

    Article  Google Scholar 

  16. Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:1365–70.

    Article  Google Scholar 

  17. Yaszay B, Bastrom TP, Bartley CE, et al. The effects of the three-dimensional deformity of adolescent idiopathic scoliosis on pulmonary function. Eur Spine J 2017;26:1658–64.

    Article  Google Scholar 

  18. Lu DS, Luk KD, Lu WW, et al. Spinal flexibility increase after chymopapain injection is dose dependent: a possible alternative to anterior release in scoliosis. Spine (Phila Pa 1976) 2004;29:123–8.

    Article  CAS  Google Scholar 

  19. Luk KD, Cheung WY, Wong Y, et al. The predictive value of the fulcrum bending radiograph in spontaneous apical vertebral derota-tion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2012;37:E922–6.

    Article  Google Scholar 

  20. Cidambi KR, Glaser DA, Bastrom TP, et al. Post-operative changes in spinal rod contour in adolescent idiopathic scoliosis: an in vivo deformation study. Spine (Phila Pa 1976) 2012;37:1566–72.

    Article  Google Scholar 

  21. Larson AN, Aubin CE, Polly Jr DW, et al. Are more screws better? A systematic review of anchor density and curve correction in adolescent idiopathic scoliosis. Spine Deform 2013;1:237–47.

    Article  Google Scholar 

  22. Serhan H, Mhatre D, Newton P, et al. Would CoCr rods provide better correctional forces than stainless steel or titanium for rigid scoliosis curves? J Spinal Disord Tech 2013;26:E70–4.

    Article  Google Scholar 

  23. Cao Y, Xiong W, Li F. Pedicle screw versus hybrid construct instrumentation in adolescent idiopathic scoliosis: meta-analysis of thoracic kyphosis. Spine (Phila Pa 1976) 2014;39:E800–10.

    Article  Google Scholar 

  24. Lonner BS, Lazar-Antman MA, Sponseller PD, et al. Multivariate analysis of factors associated with kyphosis maintenance in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2012;37:1297–302.

    Article  Google Scholar 

  25. Ilharreborde B, Pesenti S, Ferrero E, et al. Correction of hypokyphosis in thoracic adolescent idiopathic scoliosis using sublaminar bands: a 3D multicenter study. Eur Spine J 2018;27:350–7.

    Article  Google Scholar 

  26. Newton PO, Fujimori T, Doan J, et al. Defining the “three-dimensional sagittal plane” in thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 2015;97:1694–701.

    Article  Google Scholar 

  27. Parvaresh KC, Osborn EJ, Reighard FG, et al. Predicting 3D thoracic kyphosis using traditional 2D radiographic measurements in adolescent idiopathic scoliosis. Spine Deform 2017;5:159–65.

    Article  Google Scholar 

  28. Thompson JP, Transfeldt EE, Bradford DS, et al. Decompensation after Cotrel-Dubousset instrumentation of idiopathic scoliosis. Spine (Phila Pa 1976) 1990;15:927–31.

    Article  CAS  Google Scholar 

  29. Ilharreborde B, Morel E, Mazda K, et al. Adjacent segment disease after instrumented fusion for idiopathic scoliosis: review of current trends and controversies. J Spinal Disord Tech 2009;22:530–9.

    Article  Google Scholar 

  30. Kim YJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa 1976) 2008;33:2179–84.

    Article  Google Scholar 

  31. Watanabe K, Nakamura T, Iwanami A, et al. Vertebral derotation in adolescent idiopathic scoliosis causes hypokyphosis of the thoracic spine. BMC Musculoskelet Disord 2012;13:99.

    Article  Google Scholar 

  32. Demura S, Yaszay B, Carreau JH, et al. Maintenance of thoracic kyphosis in the 3D correction of thoracic adolescent idiopathic scoliosis using direct vertebral derotation. Spine Deform 2013;1:46–50.

    Article  Google Scholar 

  33. Liu H, Li Z, Li S, et al. Main thoracic curve adolescent idiopathic scoliosis: association of higher rod stiffness and concave-side pedicle screw density with improvement in sagittal thoracic kyphosis restoration. J Neurosurg Spine 2015;22:259–66.

    Article  Google Scholar 

  34. Ponte A, Vero B, Siccardi GL. Surgical treatment of Scheuermann’s hyperkyphosis. In: Winter RB, editor. Progress in Spinal Pathology: Kyphosis. Bologna: Auto Gaggi; 1984. p. 75–80.

    Google Scholar 

  35. Halanski MA, Cassidy JA. Do multilevel Ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? J Spinal Disord Tech 2013;26:252–5.

    Article  Google Scholar 

  36. Pizones J, Izquierdo E, Sanchez-Mariscal F, et al. Does wide posterior multiple level release improve the correction of adolescent idiopathic scoliosis curves? J Spinal Disord Tech 2010;23:e24–30.

    Article  Google Scholar 

  37. Shah SA, Dhawale AA, Oda JE, et al. Ponte osteotomies with pedicle screw instrumentation in the treatment of adolescent idiopathic scoliosis. Spine Deform 2013;1:196–204.

    Article  Google Scholar 

  38. Takahashi J, Ikegami S, Kuraishi S, et al. Skip pedicle screw fixation combined with Ponte osteotomy for adolescent idiopathic scoliosis. Eur Spine J 2014;23:2689–95.

    Article  Google Scholar 

  39. Abul-Kasim K, Karlsson MK, Ohlin A. Increased rod stiffness improves the degree of deformity correction by segmental pedicle screw fixation in adolescent idiopathic scoliosis. Scoliosis 2011;6:13.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

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

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

  2. Department of Orthopedics, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA

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

  3. Department of Orthopaedic Surgery, National Taiwan University Hospital, No. 7號, Zhongshan South Road, Zhongzheng District, Taipei City, 100, Taiwan

    Kuan Wen Wu MD

Authors
  1. Peter O. Newton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kuan Wen Wu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tracey P. Bastrom MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carrie E. Bartley MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vidyadhar V. Upasani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Burt Yaszay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Harms Study Group

Corresponding author

Correspondence to Peter O. Newton MD.

Additional information

This study was conducted at Rady Children’s Hospital, San Diego, CA.Author disclosures: 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; grants from Mazor Robotics, 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), KWW(none), TPB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), CEB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), VVU (other from Setting Scoliosis Straight Foundation from DePuy Synthes Spine, during the conduct of thestudy; personal fees from OrthoPediatrics, DePuy Synthes Spine, and Wolters Kluwer, outside the submitted work), 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 licensed to K2M with royalties paid), Harms Study Group (grants from DePuy Synthes Spine and EOS Imaging, during the conduct of the study; grants from NuVasive, K2M, Inc., Medtronic, and Zimmer Biomet, outside the submitted work).Funding to Setting Scoliosis Straight Foundation from DePuy Synthes Spine, K2M, NuVasive, EOS Imaging, Medtronic, and Zimmer-Biomet was received for Harms Study Group Research.IRB approval: IRB approval was obtained for this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Newton, P.O., Wu, K.W., Bastrom, T.P. et al. What Factors Are Associated With Kyphosis Restoration in Lordotic Adolescent Idiopathic Scoliosis Patients?. Spine Deform 7, 596–601 (2019). https://doi.org/10.1016/j.jspd.2018.11.006

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2018.11.006

Keywords

Search

Navigation