Can Lumbopelvic Parameters Be Used to Predict Thoracic Kyphosis at all Ages? A National Cross-Sectional Study

Solla, Federico; Ilharreborde, Brice; Blondel, Benjamin; Prost, Solène; Bauduin, Eloïse; Laouissat, Féthi; Riouallon, Guillaume; Wolff, Stéphane; Challier, Vincent; Obeid, Ibrahim; Boissière, Louis; Ferrero, Emmanuelle; Lamas, Vincent; Huec, Jean-Charles Le; Bourret, Stéphane; Faddoul, Joe; Lahoud, Georges Naïm Abi; Fière, Vincent; Kerckhove, Michiel Vande; Lebhar, Jonathan; Giorgi, H; Faure, Alice; Sauleau, Erik; Pesenti, Sébastien; Charles, Yann Philippe

doi:10.1177/21925682221134039

Cited by 3 publications

(2 citation statements)

References 35 publications

(109 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The appropriate amount of thoracic kyphosis for individual patients can be predicted using the formula suggested by Cement et al [ 22 ]. However, Pesenti et al stated that the formula had moderate accuracy, especially in patients older than 35 years of age [ 23 ]. Though prediction of the exact desired kyphosis may not be possible, an optimal amount of kyphosis restoration might help in avoiding all problems associated with persistent thoracic hypokyphosis.…”

Section: Discussionmentioning

confidence: 99%

Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating

et al. 2023

View full text Add to dashboard Cite

The emphasis of surgical correction in adolescent idiopathic scoliosis (AIS) has been given to coronal plane correction of deformity without addressing the sagittal plane thoracic hypokyphosis. Thoracic hypokyphosis has been implicated in cervical malalignment, increased incidence of proximal and distal junctional kyphosis, spinopelvic incongruence, and increased incidence of low back pain. The surgeon, variability in surgical technique, and difference in rod contouring have been implicated as factors resulting in less-than-adequate restoration of thoracic kyphosis. We hypothesised that predictable correction of hypokyphosis could be achieved by using a reproducible surgical technique with patient-specific rod templating. We describe a technique of correction of AIS with dual differential rod contouring (DDC) using patient-specific rod templating to guide intraoperative rod contouring. The pre- and post-operative radiographs of 61 patients treated using this technique were reviewed to compare correction of hypokyphosis achieved with that predicted. Analysis revealed that we achieved a kyphosis within +/− 5.5 of the predicted value. The majority of patients had a post-operative kyphosis within the optimal range of 20–40 degrees. We concluded that patient-specific rod templating in DDC helps surgeons to consistently achieve sagittal correction in AIS close to a predicted value while achieving a very good coronal plane correction.

show abstract

Section: Discussionmentioning

confidence: 99%

Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating

et al. 2023

View full text Add to dashboard Cite

show abstract

“…In the case of an insufficient TK, the patient may experience PJK and/or distal cervical kyphosis and regain balance by moving the proximal part of the spine above the fixation. The above formula is validated in AIS patients but has not been used for long follow-ups in other studies, and its accuracy in adult patients is debatable [34]. The decompensation of sagittal balance after selective thoracic and thoraco-lumbar fusions is less common in patients with kyphosis of 23 degrees or more, according to a retrospective analysis of 86 patients with Lenke 1 and 2 curves conducted by Rothenfluh et al [35].…”

Section: Post-operative Sagittal Parameters Post-operative Thoracic K...mentioning

confidence: 99%

Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

Katzouraki,

Vasiliadis,

Kaspiris

et al. 2024

JCM

View full text Add to dashboard Cite

Background: To review and evaluate multiple preoperative and postoperative sagittal parameters and their association with the risk of developing proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS) who undergo correction surgery. Methods: A systematic search was performed in December 2022 in PubMed, Embase and the Cochrane Library to retrieve all the studies relevant to our research. After the study selection and data extraction following PRISMA guidelines, RevMan 5.3 was used for statistical analysis. All the analyzed factors were evaluated by using odds ratios and weighted mean differences with 95% confidence intervals. Moreover, the meta-analysis of proportions via MedCalc was used for analyzing quantitative data from the studies. Results: A total of 22 studies were included in our meta-analysis. All the available values of sagittal parameters were evaluated. Among all the potential risk factors, higher preoperative thoracic kyphosis (Test for overall effect Z = 11.79, p < 0.00001), higher preoperative sagittal vertical axis (SVA) (test for overall effect Z = 11.19, p < 0.00001), greater thoracic kyphosis change post-op. compared to pre-op. (test for overall effect Z = 6.02, p < 0.00001), increased postoperative lumbar lordosis (test for overall effect Z = 3.65, p = 0.0003), higher post-op. SVA (test for overall effect Z = 24.93, p < 0.00001) and a larger pelvic incidence/lumbar lordosis (PI/LL) mismatch (test for overall effect Z = 20.50, p < 0.00001) were found to be the risk factors for PJK after AIS surgery. Moreover, a decreased rod contour angle (RCA) (test for overall effect Z = 3.79, p < 0.0002) and higher proximal junctional angle–rod contour angle (PJA-RCA) (test for overall effect Z = 39.18, p < 0.00001) play a significant role in the risk of developing PJK after AIS correction. Conclusions: Sagittal balance is of great importance when considering the surgical correction of AIS. Many factors in our meta-analysis were found to increase the incidence for PJK such as higher preoperative thoracic kyphosis and pre-op. SVA. Furthermore, increased thoracic kyphosis change, increased post-operative lumbar lordosis, SVA and PI/LL mismatch are also factors that influence the possibility of post-op. PJK. Lastly, RCA and PJA-RCA are two important factors that need attention during AIS, as over-contouring of the rod could lead to PJK in AIS patients.

show abstract

Patient-Specific Surgical Correction of Adolescent Idiopathic Scoliosis: A Systematic Review

Solla,

Ilharreborde,

Clément

et al. 2024

Children

View full text Add to dashboard Cite

The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods’ properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery.

show abstract

Can Lumbopelvic Parameters Be Used to Predict Thoracic Kyphosis at all Ages? A National Cross-Sectional Study

Cited by 3 publications

References 35 publications

Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating

Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating

Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

Patient-Specific Surgical Correction of Adolescent Idiopathic Scoliosis: A Systematic Review

Contact Info

Product

Resources

About