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Bone Remodeling and Disc Morphology in the Distal Unfused Spine After Spinal Fusion in Adolescent Idiopathic Scoliosis

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Abstract

Background

Morphologic changes in the vertebral body in adolescent idiopathic scoliosis (AIS) have been associated with curve development and progression. Yet, after an AIS spinal surgery, the impact of the global and local spinal realignment on the vertebral body and intervertebral disc morphologic changes, particularly in the distal unfused spine, have not been determined.

Questions/Purposes

To determine the changes in the unfused lumbar vertebrae and disc morphology two years after spinal fusion in AIS patients undergoing selective thoracic fusion (STF).

Patients and Methods

A total of 58 patients with Lenke type 1 AIS who underwent STF with a minimum two-year follow-up and 20 nonscoliotic adolescents were included. Biplanar stereoradiography of the spine at preoperative, early postoperative, and two-year follow-up were used to generate 3D models of the spine. Lumbar spine vertebral and intervertebral heights (anterior, posterior, left, and right) and the degree of wedging in the frontal and sagittal plane were calculated in the local coordinate system of the vertebral bodies. The morphology of vertebrae and discs were compared between the pre- and postoperative visits of AIS patients and nonscoliotic controls.

Results

Lumbar lordosis was not statistically different between the pre- and post-operative AIS and controls, p > .05. The contribution of the lumbar vertebral bodies and discs’ sagittal wedging to the total L1–L5 lordosis were 20% and 80%, respectively, for nonscoliotic controls and 61% and 39%, respectively, for AIS patients at two-year follow-up. The decrease in the anterior and left heights of the disc between the preoperative and two-year follow-up was significant, p < .05.

Conclusion

Patients undergoing STF for Lenke 1 AIS are able to achieve normal lumbar lordosis after surgery but seem to regain their sagittal alignment by morphologic changes in the disc more so than the vertebral body. A larger contribution of the vertebral sagittal wedging to the total lumbar lordosis at two years post STF was observed when these variables were compared to the nonscoliotic adolescents.

Level of Evidence

Level IV.

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References

  1. Lenke LG, Edwards 2nd CC, Bridwell KH. The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976) 2003;28:S199–207.

    Article  Google Scholar 

  2. Pasha S, Sankar WN, Castelein RM. The link between the 3D spinopelvic alignment and vertebral body morphology in adolescent idiopathic scoliosis. Spine Deform 2019;7:53–9.

    Article  Google Scholar 

  3. Brink RC, Schlosser TPC, Colo D, et al. Anterior spinal overgrowth is the result of the scoliotic mechanism and is located in the disc. Spine (Phila Pa 1976) 2017;42:818–22.

    Article  Google Scholar 

  4. Cheng JC, Castelein RM, Chu WC, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers 2015;1:15030.

    Article  Google Scholar 

  5. Newell N, Grant CA, Keenan BE, et al. Quantifying progressive anterior overgrowth in the thoracic vertebrae of adolescent idiopathic scoliosis patients: a sequential magnetic resonance imaging study. Spine 2016;41:E382–7.

    Article  Google Scholar 

  6. Abelin-Genevois K, Estivalezes E, Briot J, et al. Spino-pelvic alignment influences disc hydration properties after AIS surgery: a prospective MRI-based study. Eur Spine J 2015;24:1183–90.

    Article  Google Scholar 

  7. Rajasekaran S, Vidyadhara S, Subbiah M, et al. ISSLS prize winner: a study of effects of in vivo mechanical forces on human lumbar discs with scoliotic disc as a biological model: results from serial postcontrast diffusion studies, histopathology and biochemical analysis of twenty-one human lumbar scoliotic discs. Spine (Phila Pa 1976) 2010;35:1930–43.

    Article  CAS  Google Scholar 

  8. Pasha S, Flynn JM, Sponseller PD, et al. Timing of changes in three-dimensional spinal parameters after selective thoracic fusion in Lenke 1 adolescent idiopathic scoliosis: two-year follow-up. Spine Deform 2017;5:409–15.

    Article  Google Scholar 

  9. Pasha S, Cahill PJ, Flynn JM, et al; Harms Study Group. Relationships between the axial derotation of the lower instrumented vertebra and uninstrumented lumbar curve correction: radiographic outcome in Lenke 1 adolescent idiopathic scoliosis with a minimum 2-year follow-up. J Pediatr Orthop 2018;38:e194–201.

    Article  Google Scholar 

  10. Pasha S, Flynn JM, Sankar WN. Outcomes of selective thoracic fusion for Lenke 1 adolescent idiopathic scoliosis: predictors of success from the sagittal plane. Eur Spine J 2018;27:2223–32.

    Article  Google Scholar 

  11. O’Connell GD, Vresilovic EJ, Elliott DM. Human intervertebral disc internal strain in compression: the effect of disc region, loading position, and degeneration. J Orthop Res 2011;29:547–55.

    Article  Google Scholar 

  12. Stokes IA, McBride C, Aronsson DD, Roughley PJ. Metabolic effects of angulation, compression and reduced mobility on annulus fibrosis in a model of altered mechanical environment in scoliosis. Spine Deform 2013;1:161–70.

    Article  Google Scholar 

  13. Humbert L, De Guise JA, Aubert B, et al. 3D reconstruction of the spine from biplanar X-rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys 2009;31:681–7.

    Article  CAS  Google Scholar 

  14. Pasha S, Schlösser T, Zhu X, et al. Application of low-dose stereoradiography in in vivo vertebral morphologic measurements: comparison with computed tomography. J Pediatr Orthop 2017. https://doi.org/10.1097/BPO.0000000000001043 [published online June 30, 2017].

    Article  Google Scholar 

  15. Deschênes S, Charron G, Beaudoin G, et al. Diagnostic imaging of spinal deformities: reducing patients radiation dose with a new slot-scanning X-ray imager. Spine 2010;35:989–94.

    Article  Google Scholar 

  16. Pasha S, Cahill PJ, Dormans JP, Flynn JM. Characterizing the differences between the 2D and 3D measurements of spine in adolescent idiopathic scoliosis. Eur Spine J 2016;25:3137–45.

    Article  Google Scholar 

  17. Pasha S, Ecker M, Deeney V. Considerations in sagittal evaluation of the scoliotic spine. Eur J Orthop Surg Traumatol 2018;28:1039–45.

    Article  Google Scholar 

  18. Stokes IA, Burwell RG, Dangerfield PH; IBSE. Biomechanical spinal growth modulation and progressive adolescent scoliosis—a test of the “vicious cycle” pathogenetic hypothesis: summary of an electronic focus group debate of the IBSE. Scoliosis 2006;1:16.

    Article  Google Scholar 

  19. Schlosser TP, Shah SA, Reichard SJ, et al. Differences in early sagittal plane alignment between thoracic and lumbar adolescent idiopathic scoliosis. Spine J 2014;14:282–90.

    Article  Google Scholar 

  20. Landry C, Labelle H, Danserau J, et al. Morphometric characteristics of the scoliotic spine [in French]. Ann Chir 1998;52:784–90.

    CAS  PubMed  Google Scholar 

  21. Violas P, Estivalezes E, Briot J, et al. Quantification of intervertebral disc volume properties below spine fusion, using magnetic resonance imaging, in adolescent idiopathic scoliosis surgery. Spine (Phila Pa 1976) 2007;32:E405–12.

    Article  Google Scholar 

  22. Gervais J, Perie D, Parent S, et al. MRI signal distribution within the intervertebral disc as a biomarker of adolescent idiopathic scoliosis and spondylolisthesis. BMC Musculoskelet Disord 2012;13:239.

    Article  CAS  Google Scholar 

  23. Pasha S, Ilharreborde B, Baldwin K. Sagittal spinopelvic alignment after posterior spinal fusion in adolescent idiopathic scoliosis: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2019;44:41–52.

    Article  Google Scholar 

  24. Pasha S, Baldwin K. Preoperative sagittal spinal profile of adolescent idiopathic scoliosis Lenke types and non-scoliotic adolescents: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2019;44:134–42.

    Article  Google Scholar 

  25. Roussouly P, Labelle H, Rouissi J, Bodin A. Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J 2013;22(suppl 2):S203–15.

    Article  Google Scholar 

  26. Ritzman TF, Upasani VV, Bastrom TP, et al. Comparison of compensatory curve spontaneous derotation after selective thoracic or lumbar fusions in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2008;33:2643–7.

    Article  Google Scholar 

  27. Kim SS, Kim JH, Suk SI. Effect of direct vertebral rotation on the uninstrumented lumbar curve in thoracic adolescent idiopathic scoliosis. Asian Spine J 2017;11:127–37.

    Article  Google Scholar 

  28. Alexander LA, Hancock E, Agouris I, et al. The response of the nucleus pulposus of the lumbar intervertebral discs to functionally loaded positions. Spine (Phila Pa 1976) 2007;32:1508–12.

    Article  Google Scholar 

  29. Ghiss M, Giannesini B, Tropiano P, et al. Quantitative MRI water content mapping of porcine intervertebral disc during uniaxial compression. Comput Methods Biomech Biomed Engin 2016;19:1079–88.

    Article  CAS  Google Scholar 

  30. Pasha S, Flynn J. Data-driven classification of the 3D spinal curve in adolescent idiopathic scoliosis with an applications in surgical outcome prediction. Sci Rep 2018;8:16296.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., 19104, Philadelphia, PA, USA

    Saba Pasha PhD & Wudbhav N. Sankar MD

  2. Perelman School of Medicine, University of Pennsylvania, 19104, Philadelphia, PA, USA

    Saba Pasha PhD & Wudbhav N. Sankar MD

  3. Departments of Neurosurgery and Orthopaedic Surgery, University of Pennsylvania, 19104, Philadelphia, PA, USA

    Lachlan Smith PhD

Authors
  1. Saba Pasha PhD
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  2. Lachlan Smith PhD
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  3. Wudbhav N. Sankar MD
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Corresponding author

Correspondence to Saba Pasha PhD.

Additional information

Author disclosures: SP (POSNA), LS (NIH and VA grants), WNS (none).

Funding: Research funding was received from Scoliosis Research Society.

IRB approval: The study was approved by the institutional review board of the first author’s institution.

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Pasha, S., Smith, L. & Sankar, W.N. Bone Remodeling and Disc Morphology in the Distal Unfused Spine After Spinal Fusion in Adolescent Idiopathic Scoliosis. Spine Deform 7, 746–753 (2019). https://doi.org/10.1016/j.jspd.2018.12.004

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  • DOI: https://doi.org/10.1016/j.jspd.2018.12.004

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