Skip to main content
SpringerLink
Log in

Defining criteria for optimal lumbar curve correction following the selective thoracic fusion surgery in Lenke 1 adolescent idiopathic scoliosis: developing a decision tree

  • Original Article • SPINE - SCOLIOSIS
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to identify the range of optimal versus suboptimal rates of spontaneous lumbar Cobb correction (SLCC%) and the factors predicting such outcomes in a cohort of Lenke 1 adolescent idiopathic scoliosis (AIS) after posterior spinal fusion surgery.

Methods

Seventy-one consecutive Lenke1 B and C AIS patients with a fusion level to L1 and higher with two-year follow-up were included. Thoracic kyphosis (T1–T4 and T4–T12 TK), lumbar lordosis (L1-S1 LL), thoracic and lumbar Cobb angles, thoracic and lumbar apical vertebral rotations and translations (AVR and AVT), pelvic incidence, sacral slope, and sagittal and frontal balances were measured at preoperative, early postoperative, and two-year follow-up. The SLCC% was calculated between preoperative and two-year follow-up. A clustering analysis determined the subgroups of patients with significantly higher and lower (optimal versus suboptimal) rate of SLCC% in the cohort at two-year follow-up. The cutoff values of the preoperative and early postoperative radiographic parameters that significantly predicted the optimal and suboptimal SLCC% were determined using a decision tree.

Results

The averages of the optimal versus suboptimal range of SLCC% in the cohort were 72% [55%, 105%] versus 39% [− 7%, 42%]. Preoperative and early postoperative spinal parameters predicted the optimal versus suboptimal SLCC% with an accuracy of 82%, 95%CI [0.73–0.94]. Preoperative AVTLumbar < 10 mm was a predictor of optimal SLCC%. In patients with a preoperative AVTLumbar > 10 mm, early postoperative T4–T12 TK < 24° (but not less than 17°) accompanied by − 5° < AVRThoracic < 5° were the main predictors of optimal SLCC% in our cohort.

Conclusion

Quantitative clustering of the SLCC% into optimal and suboptimal groups allowed identifying the cutoff values of preoperative (AVTLumbar) and early postoperative (T4–T12 TK and AVRThoracic) spinal parameters that can predict the optimal range of SLCC% at two-year postoperative in our cohort of Lenke 1 AIS.

Level of evidence

IV

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
Fig. 4

Similar content being viewed by others

References

  1. Fischer CR, Kim Y (2011) Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy. Eur Spine J 20(7):1048–1057. https://doi.org/10.1007/s00586-011-1730-9

    Article  PubMed  PubMed Central  Google Scholar 

  2. Skaggs DL, Seehausen DA, Yamaguchi KT Jr, Hah RJ, Wright ML, Bumpass DB, Kim HJ, Andras LM, Vitale MG, Lenke LG (2016) Assessment of lowest instrumented vertebra tilt on radiographic measurements in Lenke "C" modifier curves undergoing selective thoracic fusion in adolescent idiopathic scoliosis. Spine Deform 4(2):125–130. https://doi.org/10.1016/j.jspd.2015.08.006

    Article  PubMed  Google Scholar 

  3. Pasha S, Cahill PJ, Flynn JM, Sponseller P, Newton PO, Harms Study Group (2018) 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. https://doi.org/10.1097/BPO.0000000000001136

    Article  PubMed  Google Scholar 

  4. Kim SS, Kim JH, Suk SI (2017) Effect of direct vertebral rotation on the uninstrumented lumbar curve in thoracic adolescent idiopathic scoliosis. Asian Spine J 11(1):127–137. https://doi.org/10.4184/asj.2017.11.1.127

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cho W, Faloon MJ, Essig D, Sokunbi G, Ross T, Cunningham M, Boachie-Adjei O (2018) Additional risk factors for adding-on after selective thoracic fusion in adolescent idiopathic scoliosis: implication of lowest instrumented vertebra angle and lumbosacral takeoff. Spine Deform 6(2):164–169. https://doi.org/10.1016/j.jspd.2017.08.008

    Article  PubMed  Google Scholar 

  6. Crawford CH, Lenke LG, Sucato DJ, Richards BS, Emans JB, Vitale MG, Erickson MA, Sanders JO (2013) Selective thoracic fusion in Lenke 1C curves: prevalence and criteria. Spine (Phila Pa 1976) 38(16):1380–1385. https://doi.org/10.1097/BRS.0b013e3182987360

    Article  Google Scholar 

  7. Arlet V, Marchesi D, Papin P, Aebi M (2000) Decompensation following scoliosis surgery: treatment by decreasing the correction of the main thoracic curve or "letting the spine go". Eur Spine J 9(2):156–160

    Article  CAS  Google Scholar 

  8. Frez R, Cheng JC, Wong EM (2000) Longitudinal changes in trunkal balance after selective fusion of King II curves in adolescent idiopathic scoliosis. Spine 25(11):1352–1359

    Article  CAS  Google Scholar 

  9. Roussouly P, Labelle H, Rouissi J, Bodin A (2013) 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 22(2):S203–S215. https://doi.org/10.1007/s00586-012-2571-x

    Article  PubMed  Google Scholar 

  10. Aubin CE, Cammarata M, Wang X, Thiong JM (2015) Instrumentation strategies to reduce the risks of proximal junctional kyphosis in adult scoliosis: a detailed biomechanical analysis. Spine Deform 3(3):211–218. https://doi.org/10.1016/j.jspd.2014.09.054

    Article  PubMed  Google Scholar 

  11. Chang KW, Leng X, Zhao W, Chen YY, Chen TC, Chang KI (2011) Broader curve criteria for selective thoracic fusion. Spine (Phila Pa 1976) 36(20):1658–1664. https://doi.org/10.1097/BRS.0b013e318215fa73

    Article  Google Scholar 

  12. Pasha S, Flynn JM, Sankar WN (2018) Outcomes of selective thoracic fusion for Lenke 1 adolescent idiopathic scoliosis: predictors of success from the sagittal plane. Eur Spine J. https://doi.org/10.1007/s00586-018-5553-9

    Article  PubMed  Google Scholar 

  13. Schulz J, Asghar J, Bastrom T, Shufflebarger H, Newton PO, Sturm P, Betz RR, Samdani AF, Yaszay B, Harms Study G (2014) Optimal radiographical criteria after selective thoracic fusion for patients with adolescent idiopathic scoliosis with a C lumbar modifier: does adherence to current guidelines predict success? Spine (Phila Pa 1976) 39(23):E1368–E1373. https://doi.org/10.1097/BRS.0000000000000580

    Article  Google Scholar 

  14. Sudo HS, Mayer MM, Kaneda KK, Núñez-Pereira S, Shono SY, Hitzl WH, Iwasaki NI, Koller HK (2016) Maintenance of spontaneous lumbar curve correction following thoracic fusion of main thoracic curves in adolescent idiopathic scoliosis. Bone Joint J 98-B(7):997–1002. https://doi.org/10.1302/0301-620X.98B7.37587

    Article  CAS  PubMed  Google Scholar 

  15. Koller H, Meier O, Albrecht H, Schmidt R, Zenner J, Hitzl W (2014) Selective thoracic fusion in AIS curves: the definition of target outcomes improves the prediction of spontaneous lumbar curve correction (SLCC). Eur Spine J 23(6):1263–1281. https://doi.org/10.1007/s00586-014-3280-4

    Article  PubMed  Google Scholar 

  16. Pasha S, Ecker M, Deeney V (2018) Considerations in sagittal evaluation of the scoliotic spine. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-018-2175-1

    Article  PubMed  Google Scholar 

  17. Pasha S, Cahill PJ, Dormans JP, Flynn JM (2016) Characterizing the differences between the 2D and 3D measurements of spine in adolescent idiopathic scoliosis. Eur Spine J 25(10):3137–3145. https://doi.org/10.1007/s00586-016-4582-5

    Article  PubMed  Google Scholar 

  18. DeFrancesco, CJ, Pasha S, Miller DJ, Betz RR, Clements DH, Fletcher ND, Glotzbecker, MG, Hwang SW, Kelly MP, Lehman RA, Lonner, BS, Newton PO, Roye, BD, Sponseller, PD, Upasani, VV, Cahill PJ, Group HS (2018) Agreement between manual and computerized designation of neutral vertebra in idiopathic scoliosis. Spine Deform 6(6):644–650. https://doi.org/10.1016/j.jspd.2018.03.001

    Article  PubMed  Google Scholar 

  19. Pasha S, Schlosser T, Zhu X, Castelein R, Flynn J (2017) Application of low-dose stereoradiography in in vivo vertebral morphologic measurements: comparison with computed tomography. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000001043

    Article  PubMed  Google Scholar 

  20. Stokes IA (1994) Three-dimensional terminology of spinal deformity. A report presented to the Scoliosis Research Society by the Scoliosis Research Society Working Group on 3-D terminology of spinal deformity. Spine (Phila Pa 1976) 19(2):236–248

    Article  CAS  Google Scholar 

  21. Lehman RA, Lenke LG, Helgeson MD, Eckel TT, Keeler KA (2010) Do intraoperative radiographs in scoliosis surgery reflect radiographic result? Clin Orthop Relat Res 468(3):679–686. https://doi.org/10.1007/s11999-009-0873-z

    Article  PubMed  Google Scholar 

  22. Qiu G, Zhang J, Wang Y, Xu H, Zhang J, Weng X, Lin J, Zhao Y, Shen J, Yang X, Luk KD, Lu D, Lu WW (2005) A new operative classification of idiopathic scoliosis: a peking union medical college method. Spine (Phila Pa 1976) 30(12):1419–1426

    Article  Google Scholar 

  23. Pasha S, Flynn JM, Sponseller PD, Orlando G, Newton PO, Cahill PJ, Harms Study Group (2017) Timing of changes in three-dimensional spinal parameters after selective thoracic fusion in Lenke 1 adolescent idiopathic scoliosis: two-year follow-up. Spine Deform 5(6):409–415. https://doi.org/10.1016/j.jspd.2017.04.003

    Article  PubMed  Google Scholar 

  24. Homans JF, Kruyt MC, Schlosser TPC, Colo D, Rogers K, Shah SA, Flynn JM, Castelein RM, Pasha S (2019) Changes in the position of the junctional vertebrae after posterior spinal fusion in adolescent idiopathic scoliosis: implication in risk assessment of proximal junctional kyphosis development. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000001400

    Article  Google Scholar 

  25. Pasha S, Baldwin K (2018) Preoperative sagittal spinal profile of adolescent idiopathic scoliosis Lenke types and non-scoliotic adolescents: a systematic review and meta-analysis. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000002748

    Article  Google Scholar 

  26. Pasha S, Ilharreborde B, Baldwin K (2018) Sagittal spinopelvic alignment after posterior spinal fusion in adolescent idiopathic scoliosis: a systematic review and meta-analysis. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000002736

    Article  Google Scholar 

  27. Pasha S, Baldwin K (2019) Surgical outcome differences between the 3D subtypes of right thoracic adolescent idiopathic scoliosis. Eur Spine J. https://doi.org/10.1007/s00586-019-06145-4

    Article  PubMed  Google Scholar 

  28. Sharma S, Bunger CE, Andersen T, Sun H, Wu C, Hansen ES (2015) Do postoperative radiographically verified technical success, improved cosmesis, and trunk shift corroborate with patient-reported outcomes in Lenke 1C adolescent idiopathic scoliosis? Eur Spine J 24(7):1462–1472. https://doi.org/10.1007/s00586-014-3688-x

    Article  PubMed  Google Scholar 

  29. Sudo H, Abe Y, Kokabu T, Kuroki K, Iwata A, Iwasaki N (2018) Impact of multilevel facetectomy and rod curvature on anatomical spinal reconstruction in thoracic adolescent idiopathic scoliosis. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000002628

    Article  Google Scholar 

Download references

Acknowledgements

Funding was received from Scoliosis Research Society in form of research Grant for this study.

Author information

Authors and Affiliations

  1. Division of Orthopedic Surgery, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Saba Pasha

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

    Saba Pasha

  3. Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada

    Jean-Marc Mac-Thiong

  4. Sainte-Justine University Hospital Research Center, Montreal, QC, Canada

    Jean-Marc Mac-Thiong

  5. Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada

    Jean-Marc Mac-Thiong

Authors
  1. Saba Pasha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Marc Mac-Thiong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SP designed the work and performed the acquisition and analysis of data and drafted the manuscript. SP and JM contributed to the interpretation of data for the work; revised the manuscript critically for important intellectual content; and approved the final version for publication.

Corresponding author

Correspondence to Saba Pasha.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

Institutional review board approved the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pasha, S., Mac-Thiong, JM. Defining criteria for optimal lumbar curve correction following the selective thoracic fusion surgery in Lenke 1 adolescent idiopathic scoliosis: developing a decision tree. Eur J Orthop Surg Traumatol 30, 513–522 (2020). https://doi.org/10.1007/s00590-019-02596-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-019-02596-z

Keywords

Search

Navigation