Skip to main content
SpringerLink
Log in

Cervical sagittal alignment variations in adolescent idiopathic scoliosis patients treated with thoraco-lumbo-sacral orthosis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Thoraco-lumbo-sacral orthosis (TLSO) is an effective treatment in adolescent idiopathic scoliosis (AIS) patients, but cervical sagittal alignment (CSA) variations after bracing have never been evaluated. The purpose of this study was to assess changes in CSA before, during and after TLSO treatment, and to determine whether patients developed cervical pain.

Methods

This was a retrospective study in 38 AIS patients (33 females; mean age 10.8 years) treated by TLSO. Patients were Risser 0 (n = 34) or 1 (n = 4). Major curve deformity (MC) in the coronal plane and cervical (CSA), thoracic (TSA) and lumbar (LSA) sagittal alignment were evaluated radiographically at start of treatment (t 0), after 1 month of brace treatment (t 1), and 1 year after end of treatment (t 2). Cervical pain was evaluated at t 2 using a visual analogue scale (VAS).

Results

The TLSO was worn for an average of 4.6 years. Mean CSA, TSA and LSA were significantly lower at t 2 than at t 0: 0 ± 2.5° vs. 9.4 ± 2.3°, 24.1 ± 2.6° vs. 29.3 ± 2.4° and 5 ± 1.9° vs. 44.2 ± 2.5°, respectively (p < 0.05). CSA and TSA showed moderate-good correlation (r = 0.57). CSA was normolordotic in 1/38 patients at t 2 compared to 18/38 at t 0 (p < 0.05). MC did not progress during treatment (p > 0.8). VAS score was 0 in all patients.

Conclusions

The TLSO can control progression of the deformity in the frontal plane, but it influences CSA, TSA and LSA. In particular, it decreases cervical spine lordosis, with reduction maintained 1 year after the end of treatment. Numerical differences, although statistically significant, were not clinically relevant.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Canavese F, Turcot K, De Rosa V, de Coulon G, Kaelin A (2011) Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J 20(7):1141–1148. doi:10.1007/s00586-011-1837-z

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yu M, Silvestre C, Mouton T, Rachkidi R, Zeng L, Roussouly P (2013) Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases. Eur Spine J 22(11):2372–2381. doi:10.1007/s00586-013-2753-1

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hilibrand AS, Tannenbaum DA, Graziano GP, Loder RT, Hensinger RN (1995) The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis. J Pediatr Orthop 15(5):627–632

    Article  CAS  PubMed  Google Scholar 

  4. Ilharreborde B, Vidal C, Skalli W, Mazda K (2013) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation. Eur Spine J 22(2):330–337. doi:10.1007/s00586-012-2493-7

    Article  PubMed  Google Scholar 

  5. Yagi M, Iizuka S, Hasegawa A, Nagoshi N, Fujiyoshi K, Kaneko S, Takemitsu M, Shioda M, Machida M (2014) Sagittal cervical alignment in adolescent idiopathic scoliosis. Spine Deform 2(2):122–130. doi:10.1016/j.jspd.2013.11.002

    Article  PubMed  Google Scholar 

  6. Charles YP, Sfeir G, Matter-Parrat V, Sauleau EA, Steib JP (2015) Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. Spine (Phila Pa 1976) 1 40(7):E419–E427. doi:10.1097/BRS.0000000000000767

  7. Legarreta CA, Barrios C, Rositto GE, Reviriego JM, Maruenda JI, Escalada MN, Piza-Vallespir G, Burgos J, Hevia E (2014) Cervical and thoracic sagittal misalignment after surgery for adolescent idiopathic scoliosis: a comparative study of all pedicle screws versus hybrid instrumentation. Spine (Phila Pa 1976) 15 39(16):1330–1337. doi:10.1097/BRS.0000000000000403

  8. Canavese F, Kaelin A (2011) Adolescent idiopathic scoliosis: indications and efficacy of nonoperative treatment. Indian J Orthop 45(1):7–14. doi:10.4103/0019-5413.73655

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sy N, Bettany-Saltikov J, Moramarco M (2016) Evidence for conservative treatment of adolescent idiopathic scoliosis—update 2015 (mini-review). Curr Pediatr Rev 12(1):6–11

    Article  PubMed  Google Scholar 

  10. Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 17 369(16):1512–1521. doi:10.1056/NEJMoa1307337

  11. De Giorgi S, Piazzolla A, Tafuri S, Borracci C, Martucci A, De Giorgi G (2013) Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery? Eur Spine J 22 Suppl 6:S815–S822. doi:10.1007/s00586-013-3020-1

  12. Fang MQ, Wang C, Xiang GH, Lou C, Tian NF, Xu HZ (2015) Long-term effects of the Chêneau brace on coronal and sagittal alignment in adolescent idiopathic scoliosis. J Neurosurg Spine 23(4):505–509. doi:10.3171/2015.2.SPINE14970

    Article  PubMed  Google Scholar 

  13. Rigo M, Negrini S, Weiss HR, Grivas TB, Maruyama T, Kotwicki T, SOSORT (2006) SOSORT consensus paper on brace action: TLSO biomechanics of correction (investigating the rationale for force vector selection). Scoliosis 20(1):11

    Article  Google Scholar 

  14. Cobb JR (1948) Outline for the study of scoliosis. Instr Course Lect AAOS 5:261–275

    Google Scholar 

  15. Gabos PG, Bojescul JA, Bowen JR, Keeler K, Rich L (2004) Long-term follow-up of female patients with idiopathic scoliosis treated with the Wilmington orthosis. J Bone Jt Surg Am 86-A(9):1891–1899

  16. Lee CK, Shin DA, Yi S, Kim KN, Shin HC, Yoon DH, Ha Y (2016) Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament. J Neurosurg Spine 24(1):100–107. doi:10.3171/2015.4.SPINE141004

    Article  PubMed  Google Scholar 

  17. Clément JL, Geoffray A, Yagoubi F, Chau E, Solla F, Oborocianu I, Rampal V (2013) Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis. Eur Spine J 22(11):2414–2420. doi:10.1007/s00586-013-2852-z

    Article  PubMed  PubMed Central  Google Scholar 

  18. Boseker EH, Moe JH, Winter RB, Koop SE (2000) Determination of “normal” thoracic kyphosis: a roentgenographic study of 121 “normal” children. J Pediatr Orthop 20(6):796–798

    Article  CAS  PubMed  Google Scholar 

  19. Misailidou V, Malliou P, Beneka A, Karagiannidis A, Godolias G (2010) Assessment of patients with neck pain: a review of definitions, selection criteria, and measurement tools. J Chiropr Med 9(2):49–59. doi:10.1016/j.jcm.2010.03.002

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S (2003) Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976) 1 28(1):52–62

  21. Wlodyka-Demaille S, Poiraudeau S, Catanzariti JF, Rannou F, Fermanian J, Revel M (2004) The ability to change of three questionnaires for neck pain. Jt Bone Spine 71(4):317–326

    Article  Google Scholar 

  22. Hu P, Yu M, Liu X, Zhu B, Liu X, Liu Z (2016) Analysis of the relationship between coronal and sagittal deformities in adolescent idiopathic scoliosis. Eur Spine J 25(2):409–416. doi:10.1007/s00586-015-3986-y

    Article  PubMed  Google Scholar 

  23. Mac-Thiong JM, Labelle H, Charlebois M, Huot MP, de Guise JA (2003) Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine (Phila Pa 1976) 1 28(13):1404–1409

  24. Hwang SW, Samdani AF, Tantorski M, Cahill P, Nydick J, Fine A, Betz RR, Antonacci MD (2011) Cervical sagittal plane decompensation after surgery for adolescent idiopathic scoliosis: an effect imparted by postoperative thoracic hypokyphosis. J Neurosurg Spine 15(5):491–496. doi:10.3171/2011.6.SPINE1012

    Article  PubMed  Google Scholar 

  25. Pesenti S, Blondel B, Peltier E, Choufani E, Bollini G, Jouve JL (2016) Interest of T1 parameters for sagittal alignment evaluation of adolescent idiopathic scoliosis patients. Eur Spine J 25(2):424–429. doi:10.1007/s00586-015-4244-z

    Article  CAS  PubMed  Google Scholar 

  26. Lamartina C, Berjano P, Petruzzi M, Sinigaglia A, Casero G, Cecchinato R, Damilano M, Bassani R (2012) Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21(Suppl 1):S27–S31. doi:10.1007/s00586-012-2236-9

    Article  PubMed  Google Scholar 

  27. Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 23(6):1177–1189. doi:10.1007/s00586-014-3227-9

    Article  PubMed  Google Scholar 

  28. Berjano P, Langella F, Ismael MF, Damilano M, Scopetta S, Lamartina C (2014) Successful correction of sagittal imbalance can be calculated on the basis of pelvic incidence and age. Eur Spine J 23(Suppl 6):587–596. doi:10.1007/s00586-014-3556-8

    Article  PubMed  Google Scholar 

  29. Hiyama A, Sakai D, Watanabe M, Katoh H, Sato M, Mochida J (2016) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis: a comparative study of 42 adolescents with idiopathic scoliosis and 24 normal adolescents. Eur Spine J 25(10):3226–3233

    Article  PubMed  Google Scholar 

  30. Lee CS, Noh H, Lee DH, Hwang CJ, Kim H, Cho SK (2012) Analysis of sagittal spinal alignment in 181 asymptomatic children. J Spinal Disord Tech 25(8):E259–E263. doi:10.1097/BSD.0b013e318261f346

    Article  PubMed  Google Scholar 

  31. Lou EH, Hill DL, Raso JV, Moreau M, Hedden D (2016) How quantity and quality of brace wear affect the brace treatment outcomes for AIS. Eur Spine J 25(2):495–499. doi:10.1007/s00586-015-4233-2

    Article  PubMed  Google Scholar 

  32. Mortazavi M, Gore PA, Chang S, Tubbs RS, Theodore N (2011) Pediatric cervical spine injuries: a comprehensive review. Childs Nerv Syst 27(5):705–717. doi:10.1007/s00381-010-1342-4

    Article  PubMed  Google Scholar 

  33. Scheer JK, Tang JA, Smith JS, Acosta FL Jr, Protopsaltis TS, Blondel B, Bess S, Shaffrey CI, Deviren V, Lafage V, Schwab F, Ames CP, International Spine Study Group (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19(2):141–159. doi:10.3171/2013

    Article  PubMed  Google Scholar 

  34. Protopsaltis TS, Scheer JK, Terran JS, Smith JS, Hamilton DK, Kim HJ, Mundis GM Jr, Hart RA, McCarthy IM, Klineberg E, Lafage V, Bess S, Schwab F, Shaffrey CI, Ames CP, International Spine Study Group (2015) How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up. J Neurosurg Spine 23(2):153–158. doi:10.3171/2014.11.SPINE1441

    Article  PubMed  Google Scholar 

  35. Edgar MA, Mehta MH (1988) Long-term follow-up of fused and unfused idiopathic scoliosis. J Bone Jt Surg Br 70(5):712–716

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de Chirurgie Infantile, Department of Pediatric Surgery, Centre Hospitalier Universitaire Estaing, 1 place Lucie-et-Raymond-Aubrac, 63003, Clermont-Ferrand, France

    Marco Corradin & Federico Canavese

  2. Faculty of Medicine, University of Montpellier, 1, rue de l’Ecole de Medicine, 34000, Montpellier, France

    Alain Dimeglio

  3. Académie Nationale de Médecine, 16 rue Bonaparte, 75006, Paris, France

    Jean Dubousset

Authors
  1. Marco Corradin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Federico Canavese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alain Dimeglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Dubousset
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federico Canavese.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Corradin, M., Canavese, F., Dimeglio, A. et al. Cervical sagittal alignment variations in adolescent idiopathic scoliosis patients treated with thoraco-lumbo-sacral orthosis. Eur Spine J 26, 1217–1224 (2017). https://doi.org/10.1007/s00586-016-4884-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4884-7

Keywords

Search

Navigation