Curve Characteristics and Foraminal Dimensions in Patients With Adult Scoliosis and Radiculopathy

Pugely, Andrew J.; Ries, Zachary; Gnanapragasam, Gnanapradeep; Gao, Yubo; Nash, Rachel; Mendoza-Lattes, Sergio

doi:10.1097/bsd.0b013e3182aab1e3

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…[20] Pugely et al showed that critically reduced foraminal size on computed tomography and curve concavity were associated with lower extremity radicular pain. [16] Here, we extend these findings to routine upright and supine radiographs and demonstrate, in a side- and level-specific manner, that smaller IPH is associated with radicular pain.…”

Section: Discussionsupporting

confidence: 57%

“…In a study of 384 foraminas, Pugely et al showed that caudal lumbar foraminal stenosis <40 mm 2 was associated with sciatic nerve pain and rostral lumbar foraminal stenosis <30 mm 2 was associated with formal nerve pain. Furthermore, reduced foraminal size were associated with concavity of the curve [16]. Although direct measurements of foramina were not feasible in this study due to the lack of computed tomography in patient cohorts, IPH serves as a logical correlate.…”

Section: Discussionmentioning

confidence: 99%

“…[15] Evaluation of computed tomography has also suggested an association between foraminal size and curve concavity with radiculopathy. [16] While foraminal size cannot be directly assessed on plain radiographs of the spine, we propose that the height between the pedicles that constitute the rostral and caudal boundaries of a foramen [or the interpedicular height (IPH)] could serve as a proxy measurement of foraminal size. Other clinical and radiographic modifiers likely play a role in the presentation and outcome of ADS.…”

Section: Introductionmentioning

confidence: 99%

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Interpedicular height as a predictor of radicular pain in adult degenerative scoliosis

et al. 2016

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Background Context Spine surgeons must correlate clinical presentation with radiographic findings in a patient-tailored approach. Despite the prevalence of adult degenerative scoliosis (ADS), there are few radiographic markers to predict presence of radiculopathy. Emerging data suggest that spondylolisthesis, obliquity, foraminal stenosis and curve concavity may be associated with radiculopathy in ADS. Purpose The purpose of this study was to determine if radicular pain in ADS is associated with reduced interpedicular heights (IPHs) as measured on routine radiographs. Study Design/Setting Retrospective case-controlled study. Patient Sample The authors carried out a retrospective chart review at a tertiary care referral center that included ADS patients referred to scoliosis surgeons between 2012 and 2014. Inclusion criteria included patients with ADS and no prior thoraco-lumbar surgery. Data were collected from initial spine surgeon clinic notes and radiographs. Outcome Measures Clinical outcome data included presence, side(s) and level(s) of radicular pain; presence of motor deficits; and presence of sensory deficits. Methods Variables included age, gender, Scoliosis Research Society-30 (SRS-30) and Oswestry Disability Index (ODI) questionnaire data, and radiographic measurements. Radiographic measurements included Cobb angles and L1 to S1 IPHs on upright and supine radiographs. Associations between variables and outcome measures were assessed with univariate and multivariate statistical analyses. Authors have no conflicts of interests relevant to this study. Results A total of 200 patients with an average age of 51 years met the inclusion criteria. 60/200 presented with radicular pain. Increased age was associated with radicular pain, weakness and sensory deficits. Patients that were 55 years or older were approximately 8 times more likely to have a radicular pain (OR = 7.96, 95% CI 3.73, 17.0; p <0.001), 5 times more likely to have a motor deficit (OR = 5, 95% CI 2.55, 9.79; p <0.001), and 5 times more likely to have a sensory deficit (OR = 5.2, 95% CI 2.65, 10.2; p <0.001) than those younger than 55. More caudally-located nerve roots are more likely to develop radicular pain (p <0.001). Motor deficits were associated with worse SRS-30 functional (p=0.02) and ODI scores (p=0.005), but radicular pain and sensory deficits were not associated with lower SRS-30/ODI scores. Ipsilateral and same-level radicular pain were associated with reduced IPH in supine radiographs (p=0.002 and p=0.0002, respectively). Finally, reduced IPH on upright radiographs was associated with side- and level-specific radicular pain (p = 0.04). Conclusion Radicular pain in ADS patients is associated with reduced IPHs and increased age. Measuring IPHs on routine radiographs may be helpful in associating clinical radiculopathy with radiographic measures to guide patient management and surgical planning.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Interpedicular height as a predictor of radicular pain in adult degenerative scoliosis

et al. 2016

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“…Variations in the size and shape of the foramen are often associated with symptoms of nerve root compression in the spinal region. These changes in foraminal dimensions have been commonly used to understand patho-anatomy with respect to corresponding changes in symptoms, clinical signs, or the pathophysiology of some spinal disorders [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation

Chen

You

et al. 2022

BMC Musculoskelet Disord

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Background To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation. Methods Thirty diagnosed C4/5 and/or C5/6 disc-herniated patients receiving an 8-week cervical therapeutic exercise program were followed up with videofluoroscopic images. The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements. Results The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients’ intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment. After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02–8.67% (p = 0.001 ~ 0.029), and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12–9.18% (p = 0.001 ~ 0.006) compared to the baseline. Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82–8.66% (p = 0.002 ~ 0.036 with exception of C5/6). Active lateral flexion away from the affected side significantly increased the foramen by 3.71–6.78% (p = 0.007 ~ 0.046 with exception of C6/7). Conclusions The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in intervertebral foramen areas of the patients with disc herniation. Trial registration ISRCTN61539024

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“…3 Residual thoracolumbar/lumbar scoliosis in adult patients includes the development of back pain due to degeneration of the lower lumbar spine and neurological symptoms due to degeneration of the thoracolumbar/lumbar spine. 4 The goal of surgery is to achieve nerve decompression, correct the deformity, and improve the global alignment of the spine in the coronal and sagittal planes. Unlike AIS, corrective fixation for adult scoliosis is associated with stiffness and local kyphosis of the scoliosis curve, requiring adequate intervertebral dissection and osteotomy.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes and Complications of Corrective Fusion Surgery Down to L4, L5, and the Pelvis for Adult Scoliosis in Patients Younger than 50 Years

Arima

Hasegawa

Yamato

et al. 2022

Spine Surg Relat Res

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Introduction:Corrective fusion for adult scoliosis often requires fusion from the thoracic spine to the lower lumbar spine or pelvis. However, it is often difficult to determine the lowest instrumented vertebrae (LIV), especially in younger patients. The purpose of this study was to summarize the clinical outcomes and revision surgery rates after corrective fusion for adult scoliosis at different LIV levels in patients under 50 years of age. Methods:We retrospectively analyzed 25 patients with adult scoliosis (mean age, 38 years; mean follow-up, 65 months) who underwent corrective fusion from the thoracic spine to L4, L5, or pelvis between 2010 and 2018.Preoperative and at least 2 years' postoperative radiographic parameters, patient-reported outcomes ), mechanical complications, and revision surgery were investigated, and comparisons were made between two groups: the L4 and L5 (L) group (n = 14) and the pelvic group (n = 11).Results: Both groups showed a significant improvement in the SRS-22r domains of Self-image and Subtotal postoperatively compared with the baseline (P < 0.05). The incidence of rod fracture was significantly higher in the pelvic group (5 patients, 45%) than in the L group (0 patients, 0%) (P = 0.001). In addition, revision surgery was performed five times in 4 patients (36%) in the pelvic group compared with 0 in the L group (P = 0.068). Conclusions:In the L group, clinical outcomes improved in the medium term, with no patients requiring revision surgery. In the pelvic group, the rod fracture rate was higher, but the clinical outcomes improved.

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Curve Characteristics and Foraminal Dimensions in Patients With Adult Scoliosis and Radiculopathy

Cited by 10 publications

References 27 publications

Interpedicular height as a predictor of radicular pain in adult degenerative scoliosis

Interpedicular height as a predictor of radicular pain in adult degenerative scoliosis

Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation

Clinical Outcomes and Complications of Corrective Fusion Surgery Down to L4, L5, and the Pelvis for Adult Scoliosis in Patients Younger than 50 Years

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