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Predictors of spontaneous lumbar curve correction in thoracic-only fusions: 3D analysis in AIS

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Abstract

Purpose

To evaluate how 3D parameters of the instrumented thoracic spine relate to the uninstrumented lumbar spine following thoracic-only fusion (TOF) for adolescent idiopathic scoliosis (AIS) and determine the factors predictive of lumbar correction.

Methods

A multi-center retrospective review was conducted of AIS patients with Lenke 1–4 B or C curves undergoing fusion of their thoracic spine only with minimum 2-year follow-up and 3D spine reconstructions from biplanar radiography. Pre-operative to 2-year post-operative differences were evaluated. Pearson’s correlations were used to identify 3D coronal, sagittal and axial relationships at 2 years post-operative. Multivariate linear regression was used to identify variables most predictive of lumbar curve correction.

Results

Eighty-four AIS patients met inclusion (54 B modifiers, 30 C modifiers). Average pre-operative thoracic and lumbar curves were 54 ± 9° and 41 ± 7° and corrected to 19 ± 7° and 21 ± 7°, respectively. 3D T5-T12 thoracic kyphosis increased from 6 ± 13° to 26 ± 8°. Thoracic and lumbar apical rotation decreased from − 14 ± 6° to -5 ± 6° and 13 ± 5° to 11 ± 6°, respectively. Thoracic curve correction correlated with lumbar curve correction (r = 0.67, p = 0.001) and decreased LIV tilt correlated with smaller residual lumbar curve magnitude (r = 0.63, p < 0.001). Increasing 3D kyphosis of the instrumented segment correlated with increased percentage lumbar curve correction (r = 0.29, p = 0.009). Multivariate linear regression showed LIV tilt and thoracic curve magnitude as the most predictive variables of post-operative residual lumbar curve magnitude, and percent correction of the thoracic curve and change in 3D instrumented kyphosis as most predictive of percent correction of the lumbar curve.

Conclusions

Analysis of 3D data highlights several considerations for AIS patients undergoing TOF. Maximizing thoracic curve correction, leveling the LIV, and to a lesser extent, restoring kyphosis in the instrumented segment are the factors most likely to result in greater correction of the instrumented lumbar curve following thoracic-only fusions in Lenke 1–4 B and C curves.

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Acknowledgments

Research support is gratefully acknowledged from the following: The Rady Children’s Spine Center Research Fund and Research grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group Research from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet.

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Authors and Affiliations

  1. Department of Orthopaedics, University of California, San Diego, CA, USA

    Dylan Kluck, T. Barrett Sullivan, Burt Yaszay & Peter O. Newton

  2. Division of Orthopedics and Scoliosis, Rady Children’s Hospital, 3030 Children’s Way, MC 5062, San Diego, CA, 92123, USA

    Tracey P. Bastrom, Carrie E. Bartley, Burt Yaszay & Peter O. Newton

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  1. Dylan Kluck
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  2. T. Barrett Sullivan
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Contributions

Conception or design of the work; or acquisition, analysis, or interpretation of data for the work: DK, TBS, TPB, CEB, BY, PON. Drafting or critically revising the work: DK, TBS, TPB, CEB, BY, PON. Final approval of the version to be published: DK, TBS, TPB, CEB, BY, PON.

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Correspondence to Peter O. Newton.

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Kluck, D., Sullivan, T.B., Bastrom, T.P. et al. Predictors of spontaneous lumbar curve correction in thoracic-only fusions: 3D analysis in AIS. Spine Deform 9, 461–469 (2021). https://doi.org/10.1007/s43390-020-00231-0

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