scholarly journals How Sublaminar Bands Affect Postoperative Sagittal Alignment in AIS Patients with Preoperative Hypokyphosis? Results of a Series of 34 Patients with 2-Year Follow-Up

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Sébastien Pesenti ◽  
Antoine Chalopin ◽  
Emilie Peltier ◽  
Elie Choufani ◽  
Matthieu Ollivier ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Radiographic Evaluation ◽  
Cervical Lordosis ◽  
Pelvic Parameters ◽  
Sublaminar Bands ◽  
Thoracic Idiopathic Scoliosis

Hypokyphosis is currently observed in thoracic idiopathic scoliosis. The use of sublaminar bands allows a good restoration of sagittal balance of the spine. The aim of the study was to provide a middle-term radiographic analysis of patients with adolescent idiopathic scoliosis with preoperative hypokyphosis treated by posterior arthrodesis with sublaminar bands. This retrospective study included 34 patients with Lenke 1 scoliosis associated with hypokyphosis (TK < 20°). A radiographic evaluation was performed with a 2-year follow-up. Cobb angle, cervical lordosis, thoracic kyphosis, lumbar lordosis, and pelvic parameters were measured preoperatively, postoperatively, and at 6-month and 2-year follow-up. The mean preoperative thoracic kyphosis was 10.5° versus 24.1° postoperatively (p<0.001), representing a mean gain of 13°. Cobb angle ranged from 59.3° to 17.9° postoperatively (mean correction 69%,p<0.001). Cobb angle increased between the immediate postoperative measurement and the 6-month follow-up (17.9 versus 19.9,p=0.03). Cervical curvature changed from a 5.6° kyphosis to a 3.5° lordosis (p=0.001). Concerning lumbar lordosis, preoperative measurement was 39.7° versus 41.3° postoperatively (p=0.27). At 6-month follow-up, lumbar lordosis significantly increased to 43.6° (p=0.03). All parameters were stable at final follow-up. Correction performed by sublaminar bands is efficient for both fontal and sagittal planes. Moreover, the restoration of normal thoracic kyphosis is followed by an adaptation of the adjacent curvatures with improved cervical lordosis and lumbar lordosis.

scholarly journals Sagittal curve and high metal density in adolescent idiopathic scoliosis

2014 ◽  
Vol 13 (2) ◽  
pp. 104-107 ◽  
Author(s):  
Fabio Araújo Fernandes ◽  
João Paulo Machado Bergamaschi ◽  
Luciano Antonio Nassar Pellegrino ◽  
Ricardo Shigueaki Galhego Umeta ◽  
Maria Fernanda Silber Caffaro ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pedicle Screws ◽  
Lateral View ◽  
Radiographic Evaluation ◽  
Anteroposterior Radiograph ◽  
High Metal

Objectives: To analyze radiographically the postoperative kyphosis from patients undergoing surgical treatment for AIS with pedicle screws in all vertebrae included in the arthrodesis. Methods: Retrospective study. The following measurements were evaluated: Cobb angle in anteroposterior radiograph of the three curves (proximal thoracic, main thoracic, and lumbar), Cobb angle in the lateral view of the two curves: thoracic kyphosis (T5-T12) and lumbar lordosis (T12-S1). Results: Of the 25 patients evaluated preoperatively, four (16%) were hypokyphotic, 20 patients (80%) were normokyphotic and only one (4%) was hyperkyphotic. For hypokyphotic and hiperkyphotic patients a satisfactory correction of thoracic kyphosis was obtained in 100% of cases, which was preserved in the final result. The same pattern of thoracic kyphosis was observed for all normokyphotic patients throughout the follow-up. Conclusion: Radiographic evaluation of thoracic kyphosis in patients with AIS treated surgically with pedicle screws in all vertebrae showed satisfactory results with respect to the correction of thoracic kyphosis.

scholarly journals Problems with diagnosing early stadia of scoliosis due to discrepancies between ATR and the Cobb angle

2020 ◽  
Author(s):  
Marek Kluszczyński ◽  
Jacek Wąsik ◽  
Dorota Ortenburger
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Clinical Parameters ◽  
Trunk Rotation ◽  
X Ray ◽  
False Diagnosis ◽  
Cobb Method ◽  
Threshold Rule

Abstract Background This research analysed discrepancies between the angle of trunk rotation (ATR) and the Cobb angle, in order to study if the commonly used 7° cut-off threshold for ATR helps diagnose scoliosis. In early stadia of scoliosis in children, ATR and the Cobb angle often disagree, increasing the risk of a false diagnosis: while the former does not suggest scoliosis, the latter does. Methods The study analysed ATR clinical parameters and the Cobb angle in the X-ray pictures of 117 (23 boys and 94 girls, aged 6–17 years) children who had not yet started treatment and whose X-ray pictures showed the Cobb angle of at least 10°, indicating idiopathic scoliosis. The degrees of lumbar lordosis and thoracic kyphosis were measured using the Saunders inclinometer, and back asymmetry was measured with Adam’s forward bend test using the Bunnell scoliometer. In the X-ray pictures, the curvature angle was plotted according to the Cobb method. The patients were stratified based on their age, and their ATRs and Cobb angles were compared. Results Although all the children had the Cobb angle over 10°, in 69 out of 117 (59%), ATR was below 7%. So, using the 7° cut-off threshold rule, scoliosis would not be diagnosed in those children. This shows that the two tests often disagree, suggesting that the 7° cut-off threshold or ATR is ineffective in diagnosing scoliosis. Conclusions To improve the method for diagnosing scoliosis based on ATR, consideration should be given to lowering the 7° ATR cut-off threshold.

scholarly journals Predictability of Coronal Curve Flexibility in Postoperative Curve Correction in Adolescent Idiopathic Scoliosis: The Effect of the Sagittal Profile

2019 ◽  
Vol 10 (3) ◽  
pp. 303-311 ◽  
Author(s):  
Søren Ohrt-Nissen ◽  
Hideki Shigematsu ◽  
Jason Pui Yin Cheung ◽  
Keith D. K. Luk ◽  
Dino Samartzis
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Clinical Decision Making ◽  
Sagittal Profile ◽  
Curve Correction ◽  
Sagittal Vertical Axis ◽  
Flexibility Index

Study Design: Retrospective cohort study. Objectives: To assess how the thoracic kyphosis affects the ability of the fulcrum bending radiograph (FBR) to predict the coronal thoracic curve correction. Methods: A retrospective study of prospectively collected data was conducted of 107 consecutive patients with thoracic adolescent idiopathic scoliosis (AIS) treated with a standard screw-fixation protocol. Radiographic variables were assessed preoperatively and at 2-year follow-up. Curve flexibility was determined based on the FBR and the Fulcrum Bending Flexibility Index (FBCI). Radiographic variables included preoperative Cobb angle, T5-T12 kyphosis, T12-S1 lordosis, sagittal vertical axis, list, T1-T12 length, truncal shift, and radiographic shoulder height. Patients were also categorized as hypo-, normo-, or hyperkyphotic. Results: Based on multivariate modeling, an increase in FBR Cobb angle and thoracic kyphosis were significantly associated with an increase in FBCI (increased mismatch between the FBR and postoperative Cobb angles) at 2-year follow-up ( P < 0.001). In patients with hyperkyphosis, a longer instrumented length existed despite similar curve size and shorter curve length than the hypo- and normokyphotic groups. Based on these findings, we developed a new predictive postoperative curve correction index, known as the Multiprofile Flexibility Index (MFI). Conclusions: Our results show that an increase in preoperative thoracic kyphosis is associated with an increased difference between the preoperative coronal curve flexibility and the postoperative coronal curve correction. Our findings broaden the understanding of curve flexibility and indicate that selection of fusion levels may need to take into consideration the sagittal profile to improve clinical decision making and optimize outcome.

The effect of direct vertebral rotation on the spine parameters (coronal and sagittal) in adolescent idiopathic scoliosis

2021 ◽  
pp. 1-8
Author(s):  
Carlos Eduardo Gonçales Barsotti ◽  
Carlos Augusto Belchior B. Junior ◽  
Rodrigo Mantelatto Andrade ◽  
Alexandre Penna Torini ◽  
Ana Paula Ribeiro
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Vertebral Rotation ◽  
Sacral Slope ◽  
Post Surgery ◽  
Radiographic Parameters

BACKGROUND: Idiopathic scoliosis is accompanied by postural alterations, instability of gait, and functional disabilities. The objective was to verify radiographic parameters (coronal and sagittal) of adolescents with idiopathic scoliosis (AIS) pre- and post-surgery with direct vertebral rotation (DVR), associated with type 1 osteotomies in all segments (except the most proximal) and type 2 in the periapical vertebrae of the curves. METHODS: A prospective study design was employed in which 41 AIS were evaluated and compared pre- and post-surgery. Scoliosis was confirmed by a spine X-ray exam (Cobb angle). Eight radiographic parameters were measured: Cobb angles (thoracic proximal and distal), segmental kyphosis, total kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. RESULTS: The Cobb angle averaged 51.3∘± 14.9∘. Post-surgery, there were significant reductions for the following spine measurement parameters: Cobb angle thoracic proximal (p= 0.003); Cobb angle thoracic distal (p= 0.001); Cobb angle lumbar (p= 0.001); kyphosis (T5-T12, p= 0.012); and kyphosis (T1-T12, p= 0.002). These reductions showed the effectiveness of surgical correction to reduce Cobb angles and improve thoracic kyphosis. The values obtained for lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt were not significantly different pre- and post-surgery. CONCLUSION: The surgical technique of DVR in AIS proved to be effective in the coronal and sagittal parameters directed at Cobb angles and thoracic kyphosis in order to favor the rehabilitation process.

Deformity correction in thoracic adolescent idiopathic scoliosis

2020 ◽  
Vol 102-B (3) ◽  
pp. 376-382
Author(s):  
Sébastien Pesenti ◽  
Renaud Lafage ◽  
Brice Henry ◽  
Han J. Kim ◽  
Manon Bolzinger ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Thoracic Kyphosis ◽  
Pedicle Screws ◽  
Sagittal Profile ◽  
Postoperative Phase ◽  
Coronal Correction ◽  
Sublaminar Bands

Aims To compare the rates of sagittal and coronal correction for all-pedicle screw instrumentation and hybrid instrumentation using sublaminar bands in the treatment of thoracic adolescent idiopathic scoliosis (AIS). Methods We retrospectively reviewed the medical records of 124 patients who had undergone surgery in two centres for the correction of Lenke 1 or 2 AIS. Radiological evaluation was carried out preoperatively, in the early postoperative phase, and at two-year follow-up. Parameters measured included coronal Cobb angles and thoracic kyphosis. Postoperative alignment was compared after matching the cohorts by preoperative coronal Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence. Results A total of 179 patients were available for analysis. After matching, 124 patients remained (62 in each cohort). Restoration of thoracic kyphosis was significantly better in the sublaminar band group than in the pedicle screw group (from 23.7° to 27.5° to 34.0° versus 23.9° to 18.7° to 21.5°; all p < 0.001). When the preoperative thoracic kyphosis was less than 20°, sublaminar bands achieved a normal postoperative thoracic kyphosis, whereas pedicle screws did not. In the coronal plane, pedicle screws resulted in a significantly better correction than sublaminar bands at final follow-up (73.0% versus 59.7%; p < 0.001). Conclusion This is the first study to compare sublaminar bands and pedicle screws for the correction of a thoracic AIS. We have shown that pedicle screws give a good coronal correction which is maintained at two-year follow-up. Conversely, sublaminar bands restore the thoracic kyphosis better while pedicle screws are associated with a flattening of the thoracic spine. In patients with preoperative hypokyphosis, sublaminar bands should be used to restore a proper sagittal profile. Cite this article: Bone Joint J 2020;102-B(3):376–382

scholarly journals Effect of Direct Vertebral Rotation on the Spine Parameters (Coronal and Sagittal) in Adolescent Idiopathic Scoliosis

2020 ◽  
Author(s):  
Carlos Eduardo Gonçales Barsotti ◽  
Carlos Augusto Belchior B Junior ◽  
Rodrigo Mantelatto Andrade ◽  
Alexandre Penna Torini ◽  
Ana Paula Ribeiro
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Vertebral Rotation ◽  
Sacral Slope ◽  
Post Surgery ◽  
Radiographic Parameters

Abstract Background: Idiopathic scoliosis is accompanied by postural alterations, instability of gait, and functional disabilities. The objective was to verify radiographic parameters (coronal and sagittal) of adolescents with idiopathic scoliosis (AIS) pre- and post-surgery with direct vertebral rotation (DVR), associated with type 1 osteotomies in all segments (except the most proximal) and type 2 in the periapical vertebrae of the curves. Methods: A prospective study design was employed in which 41 AIS were evaluated and compared pre- and post-surgery. Scoliosis was confirmed by a spine X-ray exam (Cobb angle). Eight radiographic parameters were measured: Cobb angles (thoracic proximal and distal), segmental kyphosis, total kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Results: The Cobb angle averaged 51.3° ± 14.9°. Post-surgery, there were significant reductions for the following spine measurement parameters: Cobb angle thoracic proximal (p = 0.003); Cobb angle thoracic distal (p=0.001); Cobb angle lumbar (p=0.001); kyphosis (T5-T12, p=0.012); and kyphosis (T1-T12, p=0.002). These reductions showed the effectiveness of surgical correction to reduce Cobb angles and improve thoracic kyphosis. The values obtained for lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt were not significantly different pre- and post-surgery. Conclusion: The surgical technique of DVR in AIS proved to be effective in the coronal and sagittal parameters directed at Cobb angles and thoracic kyphosis.

scholarly journals Spirometry Examination of Adolescents with Thoracic Idiopathic Scoliosis: Is Correction for Height Loss Useful?

2021 ◽  
Vol 10 (21) ◽  
pp. 4877
Author(s):  
Katarzyna Politarczyk ◽  
Mateusz Kozinoga ◽  
Łukasz Stępniak ◽  
Paweł Panieński ◽  
Tomasz Kotwicki
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Body Height ◽  
Radiographic Evaluation ◽  
Height Loss ◽  
The Mean ◽  
The Difference ◽  
Predicted Values ◽  
Thoracic Idiopathic Scoliosis

Loss of body height is observed in patients with idiopathic scoliosis (IS) due to spine curvatures. The study compared pulmonary parameters obtained from spirometry examination considering the measured versus the corrected body height. One hundred and twenty adolescents with Lenke type 1 or 3 IS who underwent preoperative spirometry examination and radiographic evaluation were enrolled. The mean thoracic Cobb angle was 68° ± 12.6, range 48–102°. The difference between the measured and the corrected body height increased with the greater Cobb angle. Using the corrected body height instead of the measured body height significantly changed the predicted values of pulmonary parameters and influenced the interpretation of the pulmonary testing results.

Upper instrumented vertebra to the right of the lowest instrumented vertebra as a predictor of an increase in the main thoracic curve after selective posterior fusion for the thoracolumbar/lumbar curve in Lenke type 5C adolescent idiopathic scoliosis: multicenter study on the relationship between fusion area and surgical outcome

2019 ◽  
Vol 31 (6) ◽  
pp. 857-864 ◽  
Author(s):  
Hiroki Oba ◽  
Jun Takahashi ◽  
Sho Kobayashi ◽  
Tetsuro Ohba ◽  
Shota Ikegami ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Posterior Fusion ◽  
Main Thoracic ◽  
Lowest Instrumented Vertebra ◽  
Line Tilt ◽  
The Right ◽  
Upper Instrumented Vertebra

OBJECTIVEUnfused main thoracic (MT) curvatures occasionally increase after selective thoracolumbar/lumbar (TL/L) fusion. This study sought to identify the predictors of an unacceptable increase in MT curve (UIMT) after selective posterior fusion (SPF) of the TL/L curve in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS).METHODSForty-eight consecutive patients (44 females and 4 males, mean age 15.7 ± 2.5 years, range 13–24 years) with Lenke type 5C AIS who underwent SPF of the TL/L curve were analyzed. The novel “Shinshu line” (S-line) was defined as a line connecting the centers of the concave-side pedicles of the upper instrumented vertebra (UIV) and lowest instrumented vertebra (LIV) on preoperative radiographs. The authors established an S-line tilt to the right as S-line positive (S-line+, i.e., the UIV being to the right of the LIV) and compared S-line+ and S-line− groups for thoracic apical vertebral translation (T-AVT) and MT Cobb angle preoperatively, early postoperatively, and at final follow-up. The predictors for T-AVT > 20 mm at final follow-up were evaluated as well. T-AVT > 20 mm was defined as a UIMT.RESULTSAmong the 48 consecutively treated patients, 26 were S-line+ and 22 were S-line−. At preoperative, early postoperative, and final follow-up a minimum of 2 years later, the mean T-AVT was 12.8 mm (range −9.3 to 32.8 mm), 19.6 mm (range −13.0 to 41.0 mm), and 22.8 mm (range −1.9 to 68.7 mm) in the S-line+ group, and 10.8 mm (range −5.1 to 27.3 mm), 16.2 mm (range −11.7 to 42.1 mm), and 11.0 mm (range −6.3 to 26.9 mm) in the S-line− group, respectively. T-AVT in S-line+ patients was significantly larger than that in S-line− patients at the final follow-up. Multivariate analysis revealed S-line+ (odds ratio [OR] 23.8, p = 0.003) and preoperative MT Cobb angle (OR 7.9, p = 0.001) to be predictors of a UIMT.CONCLUSIONSS-line+ was defined as the UIV being to the right of the LIV. T-AVT in the S-line+ group was significantly larger than in the S-line− group at the final follow-up. S-line+ status and larger preoperative MT Cobb angle were independent predictors of a UIMT after SPF for the TL/L curve in patients with Lenke type 5C AIS. Surgeons should consider changing the UIV and/or LIV in patients exhibiting S-line+ during preoperative planning to avoid a possible increase in MT curve and revision surgery.

scholarly journals Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Scaramuzzo ◽  
Antonino Zagra ◽  
Giuseppe Barone ◽  
Stefano Muzzi ◽  
Leone Minoia ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sagittal Profile ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

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