Thoracic Kyphosis and Lumbar Lordosis Distribution After Idiopathic Scoliosis Correction Using Posterior Hybrid Versus Screw Instrumentation.
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
received:
05
07
2020
accepted:
24
02
2021
pubmed:
27
3
2021
medline:
26
10
2021
entrez:
26
3
2021
Statut:
ppublish
Résumé
This was a retrospective observational study. The aim of this study was to evaluate kyphosis and lordosis distribution, inflexion points, and the relationship with proximal junctional kyphosis (PJK) comparing hybrid instrumentation (in situ contouring, derotation) versus screw instrumentation (thoracic cantilever reduction, lumbar in situ contouring, and derotation). The combination of reduction techniques aims at restoring the levels of lumbar apex and thoracolumbar inflexion point according to Roussouly alignment types. This approach could minimize the PJK risk after adolescent idiopathic scoliosis (AIS) surgery. The study assessed coronal curve correction, thoracolumbar and spinopelvic sagittal parameters in 86 skeletally mature adolescents and young adults 2.2 years after AIS correction, comparing a hybrid group (HG, n=34) to a screw group (SG, n=52). Segmental kyphosis and lordosis distribution, number of vertebrae included in curves, thoracic and lumbar apex, thoracolumbar inflexion point and Roussouly types were modeled using KEOPS software. Global coronal and sagittal correction were similar in both groups. In the SG, lumbar lordosis (LL) decreased from 61.1 to 53.9 degrees (P<0.0001) and matched with pelvic incidence (r=0.69), whereas LL did not change in the HG. Postoperatively, the thoracolumbar inflexion point migrated cranially, resulting in a longer LL in both groups. Postoperative thoracolumbar inflexion point (P<0.0001) and the lumbar apex (P=0.0274) were more caudal in the SG compared with the HG. The PJK rate was 14.7% in the HG and 7.7% in the SG. In patients with PJK, lumbar apex and thoracolumbar inflexion point shifted cranially and were too high according to the Roussouly type. Hybrid and screw instrumentation led to similar global AIS correction, but the use of cantilever reduction in the SG allowed setting the thoracolumbar inflexion point and the lumbar apex lower than in the HG. Cranial migration of these points was identified as PJK risk factor. Level III.
Sections du résumé
STUDY DESIGN
This was a retrospective observational study.
OBJECTIVE
The aim of this study was to evaluate kyphosis and lordosis distribution, inflexion points, and the relationship with proximal junctional kyphosis (PJK) comparing hybrid instrumentation (in situ contouring, derotation) versus screw instrumentation (thoracic cantilever reduction, lumbar in situ contouring, and derotation).
SUMMARY OF BACKGROUND DATA
The combination of reduction techniques aims at restoring the levels of lumbar apex and thoracolumbar inflexion point according to Roussouly alignment types. This approach could minimize the PJK risk after adolescent idiopathic scoliosis (AIS) surgery.
MATERIALS AND METHODS
The study assessed coronal curve correction, thoracolumbar and spinopelvic sagittal parameters in 86 skeletally mature adolescents and young adults 2.2 years after AIS correction, comparing a hybrid group (HG, n=34) to a screw group (SG, n=52). Segmental kyphosis and lordosis distribution, number of vertebrae included in curves, thoracic and lumbar apex, thoracolumbar inflexion point and Roussouly types were modeled using KEOPS software.
RESULTS
Global coronal and sagittal correction were similar in both groups. In the SG, lumbar lordosis (LL) decreased from 61.1 to 53.9 degrees (P<0.0001) and matched with pelvic incidence (r=0.69), whereas LL did not change in the HG. Postoperatively, the thoracolumbar inflexion point migrated cranially, resulting in a longer LL in both groups. Postoperative thoracolumbar inflexion point (P<0.0001) and the lumbar apex (P=0.0274) were more caudal in the SG compared with the HG. The PJK rate was 14.7% in the HG and 7.7% in the SG. In patients with PJK, lumbar apex and thoracolumbar inflexion point shifted cranially and were too high according to the Roussouly type.
CONCLUSIONS
Hybrid and screw instrumentation led to similar global AIS correction, but the use of cantilever reduction in the SG allowed setting the thoracolumbar inflexion point and the lumbar apex lower than in the HG. Cranial migration of these points was identified as PJK risk factor.
LEVEL OF EVIDENCE
Level III.
Identifiants
pubmed: 33769978
doi: 10.1097/BSD.0000000000001171
pii: 01933606-202107000-00013
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
E354-E363Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Y.P.C. is a consultant for Stryker, Clariance, and Ceraver; he received royalties and grants unrelated to this study from Stryker and Clariance. J.-P.S. is a consultant for Clariance and Zimmer-Biomet; he received royalties from Clariance, Zimmer-Biomet, and Medtronic. The remaining authors declare no conflicts of interest.
Références
Mac-Thiong JM, Labelle H, Charlebois M, et al. Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine (Phila Pa 1976). 2003;28:1404–1409.
Abelin-Genevois K, Sassi D, Verdun S, et al. Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications. Eur Spine J. 2018;27:2192–2202.
Charles YP, Bouchaïb J, Walter A, et al. Sagittal balance correction of idiopathic scoliosis using the in situ contouring technique. Eur Spine J. 2012;21:1950–1956.
Ilharreborde B, Pesenti S, Ferrero E, et al. Correction of hypokyphosis in thoracic adolescent idiopathic scoliosis using sublaminar bands: a 3D multicenter study. Eur Spine J. 2018;27:350–357.
Newton PO, Osborn EJ, Bastrom TP, et al. The 3D sagittal profile of thoracic versus lumbar major curves in adolescent idiopathic scoliosis. Spine Deform. 2019;7:60–65.
Shen J, Parent S, Wu J, et al. Towards a new 3D classification for adolescent idiopathic scoliosis. Spine Deform. 2020;8:387–396.
Rothenfluh DA, Stratton A, Nnadi C, et al. A critical thoracic kyphosis is required to prevent sagittal plane deterioration in selective thoracic fusions in Lenke I and II AIS. Eur Spine J. 2019;28:3066–3075.
Park SJ, Lee CS, Lee KJ, et al. Analysis of the change patterns of sagittal alignment values after selective thoracic fusion in Lenke 1 adolescent idiopathic scoliosis according to preoperative thoracic kyphosis status. Clin Spine Surg. 2020;33:E352–E358.
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;29:343–349.
Clément JL, Pelletier Y, Solla F, et al. Surgical increase in thoracic kyphosis increases unfused lumbar lordosis in selective fusion for thoracic adolescent idiopathic scoliosis. Eur Spine J. 2019;28:581–589.
Steib JP, Dumas R, Mitton D, et al. Surgical correction of scoliosis by in situ contouring: a detorsion analysis. Spine (Phila Pa 1976). 2004;29:193–199.
Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 2005;30:29–34.
Laouissat F, Sebaaly A, Gehrchen M, et al. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J. 2018;27:2002–2011.
Yilgor C, Sogunmez N, Boissiere L, et al. Global Alignment and Proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am. 2017;99:1661–1672.
Pizones J, Martin MB, Perez-Grueso FJS, et al. Impact of adult scoliosis on Roussouly sagittal shape classification. Spine (Phila Pa 1976). 2019;44:270–279.
Sebaaly A, Riouallon G, Obeid I, et al. Proximal junctional kyphosis in adult scoliosis: comparison of four radiological predictor models. Eur Spine J. 2018;27:613–621.
Sebaaly A, Gehrchen M, Silvestre C, et al. Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J. 2020;29:904–913.
Ferrero E, Bocahut N, Lefevre Y, et al. Proximal junctional kyphosis in thoracic adolescent idiopathic scoliosis: risk factors and compensatory mechanisms in a multicenter national cohort. Eur Spine J. 2018;27:2241–2250.
Lenke KH, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001;83:1169–1181.
Maillot C, Ferrero E, Fort D, et al. Reproducibility and repeatability of a new computerized software for sagittal spinopelvic and scoliosis curvature radiologic measurements: Keops(®). Eur Spine J. 2015;24:1574–1581.
Sebaaly A, Grobost P, Mallam L, et al. Description of the sagittal alignment of the degenerative human spine. Eur Spine J. 2018;27:489–496.
Glattes RC, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976). 2005;30:1643–1649.
Charles YP, Sfeir G, Matter-Parrat V, et al. Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. Spine (Phila Pa 1976). 2015;40:E419 27.
Pesenti S, Lafage R, Stein D, et al. The amount of proximal lumbar lordosis is related to pelvic incidence. Clin Orthop Relat Res. 2018;476:1603–1611.
Lowenstein JE, Matsumoto H, Vitale MG, et al. 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;32:448–452.
Helgeson MD, Shah SA, Newton PO, et al. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine (Phila Pa 1976). 2010;35:177–181.
Pesenti S, Lafage R, Henry B, et al. Deformity correction in thoracic adolescent idiopathic scoliosis. Bone Joint J. 2020;102-B:376–382.
Wang J, Zhao Y, Shen B, et al. Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis. Injury. 2010;41:415–420.
Wang J, Yang N, Luo M, et al. Large difference between proximal junctional angle and rod contouring angle is a risk factor for proximal junctional kyphosis. World Neurosurg. 2020;136:e683–e689.
Alzakri A, Vergari C, Van den Abbeele M, et al. Global sagittal alignment and proximal junctional kyphosis in adolescent idiopathic scoliosis. Spine Deform. 2019;7:236–244.