Changes in the cervical alignment after posterior transpedicular instrumentation in Lenke type 1 adolescent idiopathic scoliosis
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Published:
Aug 27, 2014
Keywords:
Cervical sagittal balance. Cervical scoliosis. Cervical kyphosis. Thoracic arthrodesis. T1 tilt.
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Abstract
Background: As thoracic kyphosis and cervical lordosis are proportionally related, every change in the thoracic sagittal plane will impact on the cervical alignment. Our objective was to detect changes in the sagittal cervical plane at short and medium term follow-up during surgical treatment, according to the posterior technique.Methods: Retrospective, radiographic case series study performed between January 2005 and April 2009. Inclusion criteria: Lenke type 1 adolescent idiopathic scoliosis, and posterior screw fixation surgery.Radiographic parameters: Cobb angle, uppermost instrumented vertebra, implant density, cervical lordosis, proximal thoracic kyphosis, main thoracic kyphosis, T1 sagittal tilt, global sagittal balance and cervical sagittal balance. Statistical analysis: ANOVA of repetitive samples and Tukey, using the Graph-Pad-Prism.Results: 25 patients. Mean follow-up 4.3 years. Thoracic kyphosis (T5-T12): average, preoperative 26.8º and 20.6º postoperative. Lordosing effect after surgical treatment (p ≤0.001). T1 sagittal tilt and T2-T5 proximal thoracic kyphosis (p ≤0.038) tended to increase at last control. Seventy two per cent of our sample showed rectification or even cervical kyphosis before surgery. Only 44% had certain better alignment at the last follow-up. Higher UIV correlated with a worse cervical plane alignment after surgery.Conclusions: Our derotational concavity technique with poliaxial pedicle screws and titanium 5.5 rod demonstrated a lordosing effect in the thoracic sagittal plane. This was translated into a trunk retropulsion and rectification or lost of lordosis in the sagittal cervical plane in the medium-term follow-up.
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Solsona, S., Legarreta, A. C., Rositto, G. E., Reviriego, J. M., & Escalada, M. N. (2014). Changes in the cervical alignment after posterior transpedicular instrumentation in Lenke type 1 adolescent idiopathic scoliosis. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 79(3), 169-178. https://doi.org/10.15417/337
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Clinical Research
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method of discriminate hypolordosis. Results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain
and 70 chronic neck pain subjects. Spine 2004;29(22):2485-92.
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2007;32(19S):109-14.
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instrumentation in posterior spinal fusion of AIS. Spine 2006;31:291-8.
6. Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Watanabe K, Kim YW, et al. Comparison of radiographic outcomes for the
treatment of scoliotic curves greater than 100 degrees: wires vs. hooks vs. screws. Spine 2008;33:1084-92.
7. Suk SI, Kim WJ, Kim JH, Lee SM. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between
multiple-hook and segmental pedicle screw fixation in AIS. J Spinal Disord 1999;12:489-95.
8. Suk SI, Lee SM, Chung ER, Kim JH, Kim WJ, Sohn HM. Determination of distal segmental pedicle screw fixation in single
thoracic idiopathic scoliosis. Spine 2003;28:484-91.
9. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Young-In Lee FYI, et al. Coronal and sagittal plane
correction in AIS: comparison between all pedicle screws vs. hybrid thoracic hook lumbar screws constructs. Spine 2007;32:448-
52.
10. Sucato DJ, Agrawal S, O´Brien MF, Lowe TG, Richards SB, Lenke L. Restoration of thoracic kyphosis after operative
treatment of AIS. A multicenter comparison of three surgical approaches. Spine 2008;30(24):2630-6.
11. Harms Study Group. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of AIS.
Spine 2010;35(14):1365-70.
12. Lee SM, Suk SI, Chung ER. Direct vertebral rotation: a new technique of three-dimensional deformity correction with
segmental pedicle screw fixation in AIS. Spine 2004;29:343-9.
13. Gerald M, Gibson MJ, Quan Y. Correction of main thoracic adolescent idiopathic scoliosis using pedicle screws
instrumentation. Does higher implant density improve correction? Spine 2010;35:562-7.
14. Hillibrand AS, Tannenbaum DA, Graziano GP, Loder RT, Hensinger RN. The sagittal aligment of the cervical spine in
adolescent idiopathic scoliosis. J Pediatr Orthop 1995;15:627-32.
15. Clement JL, Chau E, Kimkpe C, Vallade MJ. Restoration of thoracic kyphosis by posterior instrumentation in AIS.
Comparative radiographic analysis of two methods of reduction. Spine 2008;33(14):1579-87.
16. Westrick ER, Ward TW. AIS: 5-year to 20-year evidence-based surgical results. J Pediatr Orthop 2011;31:s61-68.
17. Harms Study Group. Evaluation of proximal junctional kyphosis in AIS following pedicle screw, hook, or hybrid
instrumentation. Spine 2010;35(2):177-81.
18. Edgar MA, Metha MH. Long term follow up of fused and unfused idiophatic scoliosis. J Bone Joint Surg Br 1988;70:712-6.
19. Moskowitz A, Moe JH, Winter RB, Binner H. Long term follow up of scoliosis fusion. J Bone Joint Surg Am 1980;62:364-76.
20. Canavese F, Turcot K, De Rosa V, de Coulon G, Kaelin A. Cervical spine sagittal aligment variations following posterior spinal
fusion and instrumentation for AIS. Eur Spine J 2011;20:1141-8.
cervical spine in compression is increased under a follower load. Spine 2000;25:1548-54.
2. Panjabi MM. Cervical spine models for biomechanical research. Spine 1998;23:2684-700.
3. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Holland B, et al. Modeling of the sagittal cervical spine as a
method of discriminate hypolordosis. Results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain
and 70 chronic neck pain subjects. Spine 2004;29(22):2485-92.
4. Reilly CW, Mulpuri K, Perdios A. Evidence-based medicine analysis of all pedicle screw constructs in AIS. Spine
2007;32(19S):109-14.
5. Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Chen G, et al. Comparative analysis of pedicle screw vs. hybrid
instrumentation in posterior spinal fusion of AIS. Spine 2006;31:291-8.
6. Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Watanabe K, Kim YW, et al. Comparison of radiographic outcomes for the
treatment of scoliotic curves greater than 100 degrees: wires vs. hooks vs. screws. Spine 2008;33:1084-92.
7. Suk SI, Kim WJ, Kim JH, Lee SM. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between
multiple-hook and segmental pedicle screw fixation in AIS. J Spinal Disord 1999;12:489-95.
8. Suk SI, Lee SM, Chung ER, Kim JH, Kim WJ, Sohn HM. Determination of distal segmental pedicle screw fixation in single
thoracic idiopathic scoliosis. Spine 2003;28:484-91.
9. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Young-In Lee FYI, et al. Coronal and sagittal plane
correction in AIS: comparison between all pedicle screws vs. hybrid thoracic hook lumbar screws constructs. Spine 2007;32:448-
52.
10. Sucato DJ, Agrawal S, O´Brien MF, Lowe TG, Richards SB, Lenke L. Restoration of thoracic kyphosis after operative
treatment of AIS. A multicenter comparison of three surgical approaches. Spine 2008;30(24):2630-6.
11. Harms Study Group. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of AIS.
Spine 2010;35(14):1365-70.
12. Lee SM, Suk SI, Chung ER. Direct vertebral rotation: a new technique of three-dimensional deformity correction with
segmental pedicle screw fixation in AIS. Spine 2004;29:343-9.
13. Gerald M, Gibson MJ, Quan Y. Correction of main thoracic adolescent idiopathic scoliosis using pedicle screws
instrumentation. Does higher implant density improve correction? Spine 2010;35:562-7.
14. Hillibrand AS, Tannenbaum DA, Graziano GP, Loder RT, Hensinger RN. The sagittal aligment of the cervical spine in
adolescent idiopathic scoliosis. J Pediatr Orthop 1995;15:627-32.
15. Clement JL, Chau E, Kimkpe C, Vallade MJ. Restoration of thoracic kyphosis by posterior instrumentation in AIS.
Comparative radiographic analysis of two methods of reduction. Spine 2008;33(14):1579-87.
16. Westrick ER, Ward TW. AIS: 5-year to 20-year evidence-based surgical results. J Pediatr Orthop 2011;31:s61-68.
17. Harms Study Group. Evaluation of proximal junctional kyphosis in AIS following pedicle screw, hook, or hybrid
instrumentation. Spine 2010;35(2):177-81.
18. Edgar MA, Metha MH. Long term follow up of fused and unfused idiophatic scoliosis. J Bone Joint Surg Br 1988;70:712-6.
19. Moskowitz A, Moe JH, Winter RB, Binner H. Long term follow up of scoliosis fusion. J Bone Joint Surg Am 1980;62:364-76.
20. Canavese F, Turcot K, De Rosa V, de Coulon G, Kaelin A. Cervical spine sagittal aligment variations following posterior spinal
fusion and instrumentation for AIS. Eur Spine J 2011;20:1141-8.