How does thoracic scoliosis surgery affect thoracolumbar spinal flexibility and lumbar intradiscal pressure? An in vitro study confirming the importance of the rib cage.
Adolescent idiopathic scoliosis
Intradiscal pressure
Lumbar spine
Range of motion
Rib cage
Thoracic spine
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
received:
03
05
2024
accepted:
13
10
2024
revised:
09
10
2024
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
aheadofprint
Résumé
To evaluate effects of spinal and rib osteotomies on the resulting spinal flexibility for surgical correction of thoracic scoliosis and to explore effects of posterior fixation on thoracolumbar segmental range of motion and lumbar intervertebral disc loading. Six fresh frozen human thoracolumbar spine and rib cage specimens (26-45 years, two female / four male) without clinically relevant deformity were loaded with pure moments of 5 Nm in flexion/extension, lateral bending, and axial rotation. Optical motion tracking of all segmental levels (C7-S) and intradiscal pressure measurements of the lumbar spine (L1-L5) were performed (1) in intact condition, (2) after Schwab grade 1, (3) Schwab grade 2, and (4) left rib osteotomies at T6-T10 levels, as well as (5) after posterior spinal fixation with pedicle screw-rod instrumentation at T4-L1 levels. Schwab grade 1 and 2 osteotomies did not significantly (p > 0.05) affect spinal flexibility, whereas left rib osteotomies significantly (p < 0.05) increased segmental ranges of motion at upper and lower levels in flexion/extension and at treated levels in lateral bending. Posterior fixation caused significantly (p < 0.05) increased range of motion at upper adjacent thoracic and mid-lumbar levels, as well as significantly (p < 0.05) increased intradiscal pressure at the lower adjacent level. Low effects of Schwab grade 1 and 2 osteotomies question the impact of isolated posterior spinal releases for surgical correction maneuvers in adolescent idiopathic scoliosis, in contrast to additional concave rib osteotomies. High effects of posterior fixation potentially explain frequently reported complications such as adjacent segment disease or proximal junctional kyphosis.
Identifiants
pubmed: 39482447
doi: 10.1007/s00586-024-08529-7
pii: 10.1007/s00586-024-08529-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Wilke H-J, Großkinsky M, Ruf M, Schlager B (2024) Range of international surgical strategies for adolescent idiopathic scoliosis: evaluation of a multi-center survey. JOR Spine 7(2):e1324. https://doi.org/10.1002/jsp2.1324
doi: 10.1002/jsp2.1324
pubmed: 38633662
pmcid: 11022599
Schlager B, Großkinsky M, Ruf M, Wiedenhöfer B, Akbar M, Wilke H-J (2024) Range of surgical strategies for individual adolescent idiopathic scoliosis cases: evaluation of a multi-centre survey. Spine Deform 12(1):35–46. https://doi.org/10.1007/s43390-023-00756-0
doi: 10.1007/s43390-023-00756-0
pubmed: 37639186
Liebsch C, Wilke H-J (2022) How does the Rib Cage affect the Biomechanical properties of the thoracic spine? A systematic literature review. Front Bioeng Biotechnol 10(904539). https://doi.org/10.3389/fbioe.2022.904539
Yoshihara H, Penny GS, Kaur H, Shah NV, Paulino CB (2019) Are inferior facetectomies adequate and suitable for surgical treatment of adolescent idiopathic scoliosis? Medicine 98(47):e18048. https://doi.org/10.1097/MD.0000000000018048
doi: 10.1097/MD.0000000000018048
pubmed: 31764829
pmcid: 6882642
Sudo H, Abe Y, Kokabu T, Kuroki K, Iwata A, Iwasaki N (2018) Impact of Multilevel Facetectomy and Rod Curvature on anatomical spinal Reconstruction in thoracic adolescent idiopathic scoliosis. Spine 43(19):E1135–E1142. https://doi.org/10.1097/BRS.0000000000002628
doi: 10.1097/BRS.0000000000002628
pubmed: 29528999
Seki S, Yahara Y, Makino H, Kawaguchi Y, Kimura T (2018) Selection of posterior spinal osteotomies for more effective periapical segmental vertebral derotation in adolescent idiopathic scoliosis - an in vivo comparative analysis between Ponte osteotomy and inferior facetectomy alone. J Orthop Sci 23(3):488–494. https://doi.org/10.1016/j.jos.2018.02.003
doi: 10.1016/j.jos.2018.02.003
pubmed: 29478623
Kokabu T, Abe Y, Yamada K, Iwasaki N, Sudo H (2021) Impact of multilevel facetectomy on segmental spinal flexibility in patients with thoracic adolescent idiopathic scoliosis. Clin Biomech 83(105296). https://doi.org/10.1016/j.clinbiomech.2021.105296
Pizones J, Izquierdo E, Sánchez-Mariscal F, Alvarez P, Zúñiga L, Gómez A (2010) Does wide posterior multiple level release improve the correction of adolescent idiopathic scoliosis curves? J Spinal Disord Tech 23(7):e24–e30. https://doi.org/10.1097/BSD.0b013e3181c29d16
doi: 10.1097/BSD.0b013e3181c29d16
pubmed: 20075750
Namikawa T, Taneichi H, Inami S, Moridaira H, Takeuchi D, Shiba Y, Nohara Y (2017) Multiple concave rib head resection improved correction rate of posterior spine fusion in treatment of adolescent idiopathic scoliosis. J Orthop Sci 22(3):415–419. https://doi.org/10.1016/j.jos.2017.01.013
doi: 10.1016/j.jos.2017.01.013
pubmed: 28202300
Mann DC, Nash CLJ, Wilham MR, Brown RH (1989) Evaluation of the role of concave rib osteotomies in the correction of thoracic scoliosis. Spine 14(5):491–495. https://doi.org/10.1097/00007632-198905000-00003
doi: 10.1097/00007632-198905000-00003
pubmed: 2727796
Holewijn RM, Kingma I, de Kleuver M, Schimmel JJP, Keijsers NLW (2017) Spinal fusion limits upper body range of motion during gait without inducing compensatory mechanisms in adolescent idiopathic scoliosis patients. Gait Posture 57(1–6). https://doi.org/10.1016/j.gaitpost.2017.05.017
Wilke H-J, Claes L, Schmitt H, Wolf S (1994) A universal spine tester for in vitro experiments with muscle force simulation. Eur Spine J 3(2):91–91. https://doi.org/10.1007/BF02221446
doi: 10.1007/BF02221446
pubmed: 7874556
Wilke H-J, Wenger K, Claes L (1998) Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J 7(2):148–154. https://doi.org/10.1007/s005860050045
doi: 10.1007/s005860050045
pubmed: 9629939
pmcid: 3611233
Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83(8):1169–1181
doi: 10.2106/00004623-200108000-00006
pubmed: 11507125
Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, Ames C, Smith JS, Shaffrey CI, Glassman S, Farcy J-P, Lafage V (2014) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 74(1):112–120. https://doi.org/10.1227/NEU.0000000000000182o
doi: 10.1227/NEU.0000000000000182o
pubmed: 24356197
Flinchum D (1963) Rib resection in the treatment of scoliosis. South Med J 56:1378–1380. https://doi.org/10.1097/00007611-196312000-00008
doi: 10.1097/00007611-196312000-00008
pubmed: 14103119
Feiertag MA, Horton WC, Norman JT, Proctor FC, Hutton WC (1995) The effect of different surgical releases on thoracic spinal motion. A cadaveric study. Spine 20(14):1604–1611. https://doi.org/10.1097/00007632-199507150-00009
doi: 10.1097/00007632-199507150-00009
pubmed: 7570176
Wiemann J, Durrani S, Bosch P (2011) The effect of posterior spinal releases on axial correction torque: a cadaver study. J Child Orthop 5(2):109–113. https://doi.org/10.1007/s11832-011-0327-5
doi: 10.1007/s11832-011-0327-5
pubmed: 22468154
pmcid: 3058210
Halsall AP, James DF, Kostuik JP, Fernie GR (1983) An experimental evaluation of spinal flexibility with respect to scoliosis surgery. Spine 8(5):482–488. https://doi.org/10.1097/00007632-198307000-00005
doi: 10.1097/00007632-198307000-00005
pubmed: 6648698
Yao X, Blount TJ, Suzuki N, Brown LK, van der Walt CJ, Baldini T, Lindley EM, Patel VV, Burger EL (2012) A biomechanical study on the effects of rib head release on thoracic spinal motion. Eur Spine J 21(4):606–612. https://doi.org/10.1007/s00586-011-2031-z
doi: 10.1007/s00586-011-2031-z
pubmed: 21989737
Helgeson MD, Shah SA, Newton PO, Clements DHr, Betz RR, Marks MC, Bastrom T, Group (2010) HS. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine 35(2):177–181. https://doi.org/10.1097/BRS.0b013e3181c77f8c
doi: 10.1097/BRS.0b013e3181c77f8c
pubmed: 20081513
Buttermann GR, Beaubien BP (2008) In vitro disc pressure profiles below scoliosis fusion constructs. Spine 33(20):2134–2142. https://doi.org/10.1097/BRS.0b013e31817d1d7f
doi: 10.1097/BRS.0b013e31817d1d7f
pubmed: 18794754
de Kleuver M, Lewis SJ, Germscheid NM, Kamper SJ, Alanay A, Berven SH, Cheung KM, Ito M, Lenke LG, Polly DW, Qiu Y, van Tulder M, Shaffrey C (2014) Optimal surgical care for adolescent idiopathic scoliosis: an international consensus. Eur Spine J 23(12):2603–2018. https://doi.org/10.1007/s00586-014-3356-1
doi: 10.1007/s00586-014-3356-1
pubmed: 24957258
Holewijn RM, Schlosser TP, Bisschop A, van der Veen AJ, Stadhouder A, van Royen BJ, Castelein RM, de Kleuver M (2015) How does spinal release and Ponte Osteotomy improve spinal flexibility? The Law of diminishing returns. Spine Deform 3(5):489–495. https://doi.org/10.1016/j.jspd.2015.03.006
doi: 10.1016/j.jspd.2015.03.006
pubmed: 27927536
Mannen EM, Arnold PM, Anderson JT, Friis EA (2017) Influence of Sequential Ponte osteotomies on the human thoracic spine with a Rib cage. Spine Deform 5(2):91–96. https://doi.org/10.1016/j.jspd.2016.10.004
doi: 10.1016/j.jspd.2016.10.004
pubmed: 28259271
Halanski MA, Cassidy JA (2013) Do multilevel Ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? J Spinal Disord Tech 26(5):252–255. https://doi.org/10.1097/BSD.0b013e318241e3cf
doi: 10.1097/BSD.0b013e318241e3cf
pubmed: 22198324
Pankowski R, Roclawski M, Ceynowa M, Mazurek T, Ciupik L, Kierzkowska A (2019) Cadaveric biomechanical testing of torque - to - failure magnitude of bilateral apical vertebral derotation maneuver in the thoracic spine. PLoS ONE 14(8):e0221494. https://doi.org/10.1371/journal.pone.0221494
doi: 10.1371/journal.pone.0221494
pubmed: 31449561
pmcid: 6709919
Sangiorgio SN, Borkowski SL, Day MJ, Ho NC, Knutsen A, Scaduto AA, Bowen RE, Ebramzadeh E (2020) Increasing loads and diminishing returns: a biomechanical study of direct vertebral rotation. Spine Deform 8(4):577–584. https://doi.org/10.1007/s43390-020-00061-0
doi: 10.1007/s43390-020-00061-0
pubmed: 32026440