Flexibility assessment of the unfused thoracic segments above the “potential upper instrumented vertebrae” using the supine side bending radiographs in Lenke 5 and 6 curves for adolescent idiopathic scoliosis patients

Kwan, Mun Keong; Chiu, Chee Kidd; Chan, Teik Seng; Gani, Siti Mariam Abd; Tan, Shun Herng; Chan, Chris Yin Wei

doi:10.1016/j.spinee.2017.06.020

Cited by 11 publications

(14 citation statements)

References 23 publications

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“…The criteria of the structural minor curve for AIS is defined as a side-bending Cobb angle of >25° or a kyphosis angle of >20°. Some methods such as push-prone and fulcrum-bending have been reported to achieve maximal preoperative correction during assessment [ 3 , 7 - 9 ]. However, side-bending X-rays are still very effective when evaluating the preoperative flexibility and structure of curves [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Long-cassette (91.44 cm) X-rays of the spine included preoperative upright PA, supine anteroposterior, and side-bending as well as prone PA and side-bending positioning. As described in a previous study, supine sidebending radiographs were obtained by maximal passive bending while keeping the neck and trunk in neutral rotation [ 7 ]. The head of the patient was turned to the bending direction during the prone position.…”

Section: Methodsmentioning

confidence: 99%

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Which Side-Bending X-ray Position is Better to Evaluate the Preoperative Curve Flexibility in Adolescent Idiopathic Scoliosis Patients, Supine or Prone?

et al. 2018

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Study DesignProspective cohort study.Purpose The present study aimed to evaluate the difference in the preoperative curve flexibility between the supine and prone positions in patients with adolescent idiopathic scoliosis (AIS).Overview of LiteratureIn AIS, a side-bending view is necessary to differentiate a structural curve from a nonstructural curve using the Lenke classification system. However, there are no published studies about which position, supine or prone, is more effective when evaluating preoperative curve flexibility using side-bending X-ray images in AIS patients.MethodsRadiographs were analyzed for 32 AIS patients (26 females, six males) who underwent posterior correction and fusion of their main thoracic (MT) curves. Cobb angles of MT, proximal thoracic (PT), and thoracolumbar/lumbar (TL/L) curves were measured preoperatively using upright, supine (anteroposterior and side-bending), and prone (posteroanterior and side-bending) X-rays.ResultsThe average Cobb angles of PT, MT, and TL/L curves on preoperative upright/supine/prone X-rays were 29.1°/26.7°/26.6°, 60.7°/48.5°/48.2°, and 41.0°/32.6°/33.1°, respectively. The average Cobb angles of PT, MT, and TL/L curves on supine/prone sidebending X-rays were 19.2°/20.3°, 36.3°/36.4°, and 13.9°/15.7°, respectively. The flexibility rates of PT, MT, and TL/L curves in supine/prone positions were 35.3%/32.5%, 40.6%/40.2%, and 71.7%/68.2%, respectively. Comparing flexibility rates in the prone position with those in the supine position in each case, the average ratios of PT, MT, and TL/L curves were found to be 1.0, 1.0, and 0.9, respectively. There were no statistically significant differences between supine and prone side-bending X-ray measurements. However, the Lenke classification in six of 32 patients (18.8%) differed between supine and prone positions because the TL/L curve in the supine position was slightly more flexible than in the prone position.ConclusionsSupine side-bending films may be suitable for the evaluation of preoperative curve flexibility in AIS, especially for lumbar modifier C.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Which Side-Bending X-ray Position is Better to Evaluate the Preoperative Curve Flexibility in Adolescent Idiopathic Scoliosis Patients, Supine or Prone?

et al. 2018

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“…It is critical to fuse the less mobile segments to achieve optimal global balance during the treatment for patients with Lenke 5C AIS [ 3 , 9 ]. The choice of a too proximal LIV may result in distal curve decompensation, while a too distal LIV may cause a needless sacrifice of lumbar motion [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Distal adding-on after surgery in Lenke 5C adolescent idiopathic scoliosis: clinical and radiological outcomes

Hua

Liao

et al. 2022

BMC Musculoskelet Disord

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Background To evaluate the incidence and risk factors of postoperative distal adding-on in patients with Lenke 5C adolescent idiopathic scoliosis (AIS). More accurate selection criteria for the lower instrumented vertebra (LIV) should be confirmed to prevent distal adding-on. Methods Forty-six patients with Lenke 5C AIS who underwent posterior fusion were enrolled in the study. Patients were allocated into adding-on and no adding-on groups. Demographic data, clinical data, and radiographic parameters were recorded and compared. Results Postoperative distal adding-on occurred in eight patients (17.4%) during follow-up. Demographic data, clinical data, and baseline radiographic parameters of the two groups were not significantly different. The postoperative thoracolumbar (TL) or lumbar (L) Cobb angle, LIV translation, and LIV + 1 translation were higher in the adding-on group than those in the no adding-on group, while the postoperative coronal imbalance of the adding-on group was lower than that of the no adding-on group. The level difference of last barely touched vertebra (LBTV) and last substantial touched vertebra (LSTV) with LIV were higher in the adding-on group than in the no adding-on group. Conclusion Postoperative TL/L curve, postoperative LIV translation, postoperative LIV + 1 translation, and postoperative coronal imbalance were determined as risk factors for postoperative distal adding-on in patients with Lenke 5C AIS. Moreover, LIV selection of LBTV-1 or LSTV-1 may cause a higher risk of postoperative distal adding-on.

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“…Extended fusion had more correction in the coronal plane with less restoration of TK [14,15]. In our study, the extended fusion group had a significantly immediate, larger reduction in TK.…”

Section: Proximal Junctional Kyphosis and Extendned Fusionmentioning

confidence: 41%

“…Posterior thoracolumbar/lumbar (TL/L) fusion is commonly used for Lenke 5C (AIS) [9,10]. To avoid the progression of the unfused thoracic curve after thoracolumbar/lumbar (TL/L) fusion, experienced surgeons may choose to perform extended fusion in patients with Lenke 5C AIS with a bending thoracic Cobb angle of more than 20° [11.12.13.15].Furthermore, Kwan et al [14] suggested extended fusion with a bending thoracic curve of more than 15°. However, the extended fusion may strongly reduce the thoracic kyphosis (TK) in the sagittal profile [14,15], and the reduction of TK is a proven risk factor for proximal junctional kyphosis (PJK) and may also result in great change in thoracervical parameters in AIS patients [2.4.5.16-20].…”

Section: Introductionmentioning

confidence: 99%

Postoperative proximal junctional kyphosis in Lenke 5C adolescent idiopathic scoliosis following posterior surgery: extending fusion versus thoracolumbar/lumbar fusion

Wang

et al. 2020

Preprint

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Background: Proximal junctional kyphosis is a common complication after posterior fusion in adolescent idiopathic scoliosis patients, and was correlated with postoperative change of thoracic kyphosis. However, no previous literature has evaluated the correlation of PJK with thoracervical parameters in the AIS patients. Methods: Data from 61 patients who underwent posterior fusion for Lenke 5C AIS and had 2 years of follow-up were retrospectively reviewed. Patients were fused higher than two levels above the upper-end-vertebra in the extended fusion group (n=32), whereas they were fused below or at UEV+2 in the TL/L fusion group (n=29). Results: During an average follow-up of 32.5 months, 14/61 patients had PJK. The extended fusion group had a greater incidence of PJK than the TL/L fusion group did (11/32 vs. 3/29,P = 0.03) and a significant more decrease of TK than the TL/L group(p<0.01). Patients with PJK had a significantly larger Thoracic inlet angle(TIA) than those without PJK (P <0.01). Multivariate analysis revealed a greater preoperative TIA to be a positive predictor for PJK (p = 0.015). TIA >72° with extended fusion was a risk factor for PJK at final follow-up. The SRS-22 score did not significantly differ between the extended fusion and TL/L fusion groups. Conclusions: TIA could be a predictor of PJK. In Lenke 5C AIS patients, those with TIA >72° were more likely to develop PJK. And extended fusion in patients with Lenke 5C adolescent idiopathic scoliosis may be at an increased risk of proximal junctional kyphosis.

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Flexibility assessment of the unfused thoracic segments above the “potential upper instrumented vertebrae” using the supine side bending radiographs in Lenke 5 and 6 curves for adolescent idiopathic scoliosis patients

Cited by 11 publications

References 23 publications

Which Side-Bending X-ray Position is Better to Evaluate the Preoperative Curve Flexibility in Adolescent Idiopathic Scoliosis Patients, Supine or Prone?

Which Side-Bending X-ray Position is Better to Evaluate the Preoperative Curve Flexibility in Adolescent Idiopathic Scoliosis Patients, Supine or Prone?

Distal adding-on after surgery in Lenke 5C adolescent idiopathic scoliosis: clinical and radiological outcomes

Postoperative proximal junctional kyphosis in Lenke 5C adolescent idiopathic scoliosis following posterior surgery: extending fusion versus thoracolumbar/lumbar fusion

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