Preservation of Thoracic Kyphosis is Critical to Maintain Lumbar Lordosis in The Surgical Treatment of Adolescent Idiopathic Scoliosis

  • Mohammad Khakinahad Mail Department of Spine Surgery, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Ebrahim Ameri Department of Orthopaedic Spine Surgery, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Hassan Ghandhari Department of Orthopaedic Spine Surgery, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Hossein Tari Department of Orthopaedic Spine Surgery, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Idiopathic scoliosis, Thoracic kyphosis, Lumbar lordosis, Hook instrumentation

Abstract

Restoration of the sagittal alignment is one of the fundamental goals in scoliosis correction surgery. Having an increase in popularity of segmental spinal instrumentation, thoracic kyphosis (TK) is often sacrificed to achieve frontal and axial plane correction. Patients with a Lenke type 1 deformity underwent selective thoracic fusion (lowest instrumented vertebra of T12 or L1) using corrective segmental spinal instrumentation (Hook-Rod) and were followed up for 2 years. They were evaluated before and after operation for coronal and sagittal alignments using standing anteroposterior and lateral radiographs. There were 63 patients (21 male, 42 female) with a mean age of 15.8±2.1 years included to this study. TK reduction had significant correlation (P≤0.001) with lumbar lordosis (LL) decrease at preoperative (r=0.47), immediately postoperative (r=0.37) and at 2-year follow-up (r=0.5). The decrease in LL after 2-years was less than decrease in TK (4.5±8.5 vs 6±10, respectively).

References

Majdouline Y, Aubin CE, Robitaille M, Sarwark JF, Labelle H. Scoliosis correction objectives in adolescent idiopathic scoliosis. J Pediatr Orthop 2007;27(7):775-81.

Bridwell KH. Surgical treatment of idiopathic adolescent scoliosis. Spine (Phila Pa 1976) 1999;24(24):2607-16.

Lee SM, Suk SI, Chung ER. Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2004;29(3):343-9.

Lagrone MO, Bradford DS, Moe JH, Lonstein JE, Winter RB, Ogilvie JW. Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg Am 1988;70(4):569-80.

Potter BK, Lenke LG, Kuklo TR. Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am 2004;86-A(8):1793-808.

La Grone MO. Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am 1988;19(2):383-93.

Cotrel Y, Dubousset J, Guillaumat M. New universal instrumentation in spinal surgery. Clin Orthop Relat Res 1988;227:10-23.

Muschik M, Schlenzka D, Robinson PN, Kupferschmidt C. Dorsal instrumentation for idiopathic adolescent thoracic scoliosis: rod rotation versus translation. Eur Spine J1999;8(2):93-9.

Suk SI, Lee CK, Chung SS. Comparison of Zielke ventral derotation system and Cotrel-Dubousset instrumentation inthe treatment of idiopathic lumbar and thoracolumbar scoliosis. Spine (Phila Pa 1976) 1994;19(4):419-29.

Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 1995;20(12):1399-405.

de Jonge T, Dubousset JF, Illés T. Sagittal plane correction in idiopathic scoliosis. Spine (Phila Pa 1976) 2002;27(7):754-60.

Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 2007;32(4):448-52.

Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G, Sides B. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2006;31(3):291-8.

Vora V, Crawford A, Babekhir N, Boachie-Adjei O, Lenke L, Peskin M, Charles G, Kim Y. A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine (Phila Pa 1976) 2007;32(17):1869-74.

Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976)= 2004;29(18):2040-8.

Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG, Lowe T, Crawford A, Betz R, Lonner B;Harms Study Group. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35(14):1365-70.

Willers U, Hedlund R, Aaro S, Normelli H, Westman L. Long-term results of Harrington instrumentation in idiopathic scoliosis. Spine (Phila Pa 1976) 1993;18(6):713-7.

Luk KD, Vidyadhara S, Lu DS, Wong YW, Cheung WY, Cheung KM. Coupling between sagittal and frontal planedeformity correction in idiopathic thoracic scoliosis and its relationship with postoperative sagittal alignment. Spine(Phila Pa 1976) 2010;35(11):1158-64.

Bridwell KH, Hanson DS, Rhee JM, Lenke LG, Baldus C, Blanke K. Correction of thoracic adolescent idiopathic scoliosis with segmental hooks, rods, and Wisconsin wires posteriorly: it's bad and obsolete, correct? Spine (Phila Pa 1976) 2002;27(18):2059-66.

de Jonge T, Dubousset JF, Illés T. Sagittal plane correction in idiopathic scoliosis. Spine (Phila Pa 1976) 2002;27(7):754-60.

Lenke LG, Bridwell KH, Baldus C, Blanke K, Schoenecker PL. Cotrel-Dubousset instrumentation foradolescent idiopathic scoliosis. J Bone Joint Surg Am 1992;74(7):1056-67.

Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB. Segmental pedicle screw fixation in the treatment of thoracicidiopathic scoliosis. Spine (Phila Pa 1976) 1995;20(12):1399-405.

Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Watanabe K, Kim YW, Kim YB, Hensley M, Stobbs G. Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees: wires versus hooks versus screws. Spine (Phila Pa 1976) 2008;33(10):1084-92.

How to Cite
1.
Khakinahad M, Ameri E, Ghandhari H, Tari H. Preservation of Thoracic Kyphosis is Critical to Maintain Lumbar Lordosis in The Surgical Treatment of Adolescent Idiopathic Scoliosis. Acta Med Iran. 50(7):477-481.
Section
Articles