Reciprocal Changes in Sagittal Alignment With Operative Treatment of Adolescent Scheuermann Kyphosis—Prospective Evaluation of 96 Patients

Lonner, Baron S.; Parent, Stefan; Shah, Suken A.; Sponseller, Paul D.; Yaszay, Burt; Samdani, Amer F.; Cahill, Patrick J.; Pahys, Joshua M.; Betz, Randal R.; Ren, Yuan; Shufflebarger, Harry L.; Newton, Peter O.

doi:10.1016/j.jspd.2017.07.001

Cited by 19 publications

(8 citation statements)

References 17 publications

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“…In the present study, the mean values of preoperative TK and LL were pf 83°and 66°respectively. After surgical correction of hyperkyphosis, the mean value of LL was of 47°, so there was a spontaneous improvement in the lumbar hyperlordosis at levels not included in the fusion, as described in the literature [13][14][15][16][17] and also verified by Ashraf et al 16 in a retrospective study of 18 patients submitted to surgical treatment.…”

Section: Discussionsupporting

confidence: 55%

“…Neste estudo, os valores médios da TK pré-operatória e da LL foram de 83°e 66°, respectivamente. Após a correção cirúrgica da hipercifose, o valor médio da LL foi de 47°, por isso houve melhora espontânea da hiperlordose lombar em níveis não incluídos na fusão, conforme descrito na literatura [13][14][15][16][17] e também verificado por Ashraf et al 16 em estudo retrospectivo de 18 pacientes submetidos ao tratamento cirúrgico.…”

Section: Discussionunclassified

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Alinhamento do plano sagital e resultados funcionais após cirurgia para a cifose de Scheuermann

Vital

Nunes

Santos

et al. 2021

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar e correlacionar os parâmetros pélvicos, o equilíbrio sagital (SB), e o resultado funcional dos pacientes submetidos ao tratamento cirúrgico da hipercifose de Scheuermann (SK). Métodos Foram incluídos pacientes submetidos à cirurgia entre janeiro de 2005 e dezembro de 2016. Foram obtidas as seguintes medidas radiográficas: cifose torácica (TK); lordose lombar (LL); SB; incidência pélvica (PI); inclinação pélvica (PT); e inclinação sacral (SS). Complicações foram registradas durante o período de seguimento. Resultados Foram incluídos 19 pacientes (16 homens): a cifose pré-operatória média foi de 83°, e, após a cirurgia, de 57°. A LL média pré-operatória foi de 66°, com uma correção espontânea pós-operatória de 47°. Quanto aos parâmetros pélvicos pré-operatórios, as médias de PI, PT e SS foram de 48°, 10° e 39°, respectivamente. No pós-operatório, esses valores foram de 50°, 16° e 35°, respectivamente. O SB pré-operatório foi neutro e mantido após correção cirúrgica. Quanto às complicações durante o período de seguimento, foram observadas três cifoses juncionais – duas necessitando de cirurgia de revisão, uma má consolidação, e uma deiscência de sutura. Em relação aos resultados funcionais, a pontuação média no questionário de 22 itens da Scoliosis Research Society (SRS-22) foi de 4,04, e verificou-se que o SB no pós-operatório não teve influência no desfecho funcional (p = 0,125), nem na LL pós-operatória (p = 0,851). Conclusão Verificamos uma melhora espontânea da hiperlordose lombar em níveis não incluídos na fusão após a correção da TK. Embora os resultados funcionais pós-operatórios tenham sido globalmente elevados, não encontramos nenhuma relação estatisticamente significativa com a TK nem com a LL. A PI elevada está associada a maior complicação da cifose juncional proximal (PJK), e esses parâmetros pélvicos devem ser considerados no momento do tratamento cirúrgico da cifose de Scheuermann.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionunclassified

Alinhamento do plano sagital e resultados funcionais após cirurgia para a cifose de Scheuermann

Vital

Nunes

Santos

et al. 2021

Rev Bras Ortop (Sao Paulo)

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“…12 Similarly, Lonner et al found that postsurgery movement of the TK apex in adolescent patients with Scheuermann kyphosis improved SRS questionnaire outcomes. 13 This notion is further supported by the enhanced improvements seen in the ST2R-associated SRS-22r outcomes, compared with the RR cohort. Taken together, these data suggest that the TK apex is an indicator for improvement in quality of life.…”

Section: Discussionmentioning

confidence: 88%

“…It is known that the apex has a major influence on the shape of the back, which determines the posture and is thus likely to affect important factors such as self-image and disability, 12 which is complemented by non-AIS-specific deformity correction studies suggesting that apex improvements are associated with enhanced clinical outcomes. 12,13 A recent retrospective study of 36 AIS patients by Faldini et al 4 described an ST2R adaptation involving asymmetrically contoured rods fitted to the desired sagittal shape, including a convexity at the desired apex level. The authors reported significant improvements in the TK angle and overall quality of life and noted that their technique allows for the manipulation of the TK apex level to a more desired height.…”

mentioning

confidence: 99%

Simultaneous translation on two rods improves the correction and apex translocation in adolescent patients with hypokyphotic scoliosis

Sakai

Schol

Hiyama

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEThe objectives of this study were to apply the simultaneous translation on two rods (ST2R) maneuver involving rods contoured with a convexity at the desired thoracic kyphosis (TK) apex level and to assess the effects on the ability to support triplanar deformity corrections, including TK apex improvement, in patients with hypokyphotic adolescent idiopathic scoliosis (AIS).METHODSUsing retrospective analysis, the authors examined the digital records that included 2- to 4-week, 1-year, and 2-year postoperative radiographic follow-up data of female hypokyphotic (TK < 20°) AIS patients (Lenke type 1–3) treated with ST2R. The authors assessed the corrections of triplanar deformities by examining the main Cobb angle, TK, rib hump, apical vertebral rotation, Scoliosis Research Society 22-item questionnaire scores, and TK apex translocation. In order to better grasp the potential of ST2R, the outcomes were compared with those of a historical matched case-control cohort treated with a standard rod rotation (RR) maneuver.RESULTSData were analyzed for 25 AIS patients treated with ST2R and 27 patients treated with RR. The ST2R group had significant improvements in the main Cobb angle and TK, reduction in the rib hump size at each time point, and a final correction rate of 72%. ST2R treatment significantly increased the kyphosis apex by an average of 2.2 levels. The correction rate was higher at each time point in the ST2R group than in the RR group. ST2R engendered favorable TK corrections, although the differences were nonsignificant, at 2 years compared with the RR group (p = 0.056). The TK apex location was significantly improved in the ST2R cohort (p < 0.001). At the 1-month follow-up, hypokyphosis was resolved in 92% of the ST2R cohort compared with 30% of the RR cohort.CONCLUSIONSResolving hypokyphotic AIS remains challenging. The ST2R technique supported significant triplanar corrections, including TK apex translocation and restoration of hypokyphosis in most patients. Comparisons with the RR cohort require caution because of differences in the implant profile. However, ST2R significantly improved the coronal and sagittal corrections. It also allowed for distribution of correctional forces over two rod implants instead of one, which should decrease the risk of screw pullout and rod flattening. It is hoped that the description here of commercially available reducers used with the authors’ surgical technique will encourage other clinicians to consider using the ST2R technique.

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“…Lonner et al [19] reviewed ninety-six surgical SK patients and found the apex localized between T5-T8 in 68.5% of patients with a preoperative apex caudal to T8, Fig. 1 Comparison of the distribution of the thoracic apex preoperatively, postoperatively and at the final follow-up whereas 90% of patients with a preoperative apex between T5 and T8 remained unchanged; Changes in thoracic apex location were associated with improvements in the SRS function domain.…”

Section: Discussionmentioning

confidence: 98%

The effect of pedicle subtraction osteotomy for the correction of severe Scheuermann thoracolumbar kyphosis on sagittal spinopelvic alignment

Lin

Wang

Yang

et al. 2021

BMC Musculoskelet Disord

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Purpose To analyze how pedicle subtraction osteotomy (PSO) treatment of severe Scheuermann thoracolumbar kyphosis (STLK) using pedicle screw instrumentation affects sagittal spinopelvic parameters. Background The medical literature on the post-surgical effects of treatments such as Ponte osteotomy is limited, but suggests few effects on spinopelvic profiles. Currently, there is no research regarding changes in sagittal spinopelvic alignment upon PSO treatment in STLK patients. Methods We performed a retrospective study on 11 patients with severe STLK. These patients underwent posterior-only correction surgeries with PSO and pedicle screw instrumentation between 2012 to 2017 in a single institute. Patients were measured for the following spinopelvic parameters: global kyphosis (GK), thoracic kyphosis (TK), thoracolumbar kyphosis (TL), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tile (PT), sacral slope (SS), and administered a Scoliosis Research Society-22 questionnaire (SRS-22) pre-operation, post-operation and at final follow-up. Results GK improved from a median of 74.1° to 40.0° after surgery, achieving a correction rate of 48.8% with a median correction loss of 0.8°. TK, TL and LL all showed significant difference (P < 0.05) and SVA improved 22.7 (11.6, 30.9) mm post operation. No significant difference was found in pelvic parameters (PI, PT, SS, all P < 0.05). The absolute value of LL- PI significantly improved from a median of 26.5° pre-operation to 6.1° at the final follow-up. 72.7% in this series showed an evident trend of thoracic and lumbar apices migrating closer to ideal physiological segments after surgery. Self-reported scores of pain, self-image, and mental health from SRS-22 revealed significant improvement at final follow-up (all P < 0.05). Conclusions PSO treatment of severe STLK with pedicle screw instrumentation can improve spine alignment and help obtain a proper alignment of the spine and the pelvis.

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Reciprocal Changes in Sagittal Alignment With Operative Treatment of Adolescent Scheuermann Kyphosis—Prospective Evaluation of 96 Patients

Cited by 19 publications

References 17 publications

Alinhamento do plano sagital e resultados funcionais após cirurgia para a cifose de Scheuermann

Alinhamento do plano sagital e resultados funcionais após cirurgia para a cifose de Scheuermann

Simultaneous translation on two rods improves the correction and apex translocation in adolescent patients with hypokyphotic scoliosis

The effect of pedicle subtraction osteotomy for the correction of severe Scheuermann thoracolumbar kyphosis on sagittal spinopelvic alignment

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