Including the stable sagittal vertebra in the fusion for adolescent idiopathic scoliosis reduces the risk of distal junctional kyphosis in Lenke 1–3 B and C curves

Marciano, Gerard; Ball, Jacob; Matsumoto, Hiroko; Roye, Benjamin; Lenke, Lawrence G.; Newton, Peter O.; Vitale, Michael G.

doi:10.1007/s43390-020-00259-2

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…Two studies ( 13 , 14 ) investigated whether body mass index (BMI) affects DJK. The studies had high heterogeneity ( p for heterogeneity = 0.04, I 2 = 75%, Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies ( 10 , 13 , 14 ) investigated the relationship between preoperative TLK and DJK. The studies had low heterogeneity ( p for heterogeneity = 0.37, I 2 = 0%, Figure 5E ).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies ( 11 , 14 , 15 ) investigated whether LIV relative to SSV affected DJK. There was no significance in the test for heterogeneity; thus, the studies had low heterogeneity ( p for heterogeneity = 0.36, I 2 = 2%, Figure 6 ).…”

Section: Resultsmentioning

confidence: 99%

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Risk factors for distal junctional kyphosis after posterior spinal surgery in adolescent idiopathic scoliosis: a meta-analysis

Jia,

Long

2023

Front. Surg.

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IntroductionDistal junctional kyphosis (DJK) is a serious complication after posterior spinal surgery in managing adolescent idiopathic scoliosis (AIS). Our study aims to investigate the predictors of DJK in AIS patients.MethodsWe searched the English databases of PubMed, Embase, and the Cochrane Library for clinical research studies on AIS. To identify the risk factors for DJK, we collected demographic data, such as age, gender, and body mass index (BMI), and sagittal parameters, including preoperative pelvic tilt (PT), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), distal junctional angle (DJA), lowest instrumented vertebrae (LIV) relative to sagittal stable vertebrae (SSV), and postoperative DJA. Data were analyzed by RevMan (5.3 version) and STATA (12.0 version).ResultsFinally, six included articles (1,240 patients) showed 9% (98 of 1,240 patients) of patients suffering from DJK. Our findings indicated that preoperative TK [p = 0.007, OR = 0.35, 95% CI (0.10, 0.61)], TLK [p < 0.0001, OR = 5.99, 95% CI (3.33, 8.65)], and postoperative DJA [p = 0.002, OR = 0.56, 95% CI (0.21, 0.91)] in the DJK group were markedly higher than those in the non-DJK group. Moreover, patients with LIV above SSV [p < 0.0001, OR = 7.95, 95% CI (4.16, 15.22)] were more likely to develop DJK. No discernible difference was found in age, sex, BMI, preoperative PT, SVA, LL, or DJA between the two groups.ConclusionsRegarding the AIS patients, factors such as higher preoperative TK and TLK, higher postoperative DJA, and LIV above the SSV were related to an increased rate of DJK.

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“…Two studies ( 13 , 14 ) investigated whether body mass index (BMI) affects DJK. The studies had high heterogeneity ( p for heterogeneity = 0.04, I 2 = 75%, Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies ( 10 , 13 , 14 ) investigated the relationship between preoperative TLK and DJK. The studies had low heterogeneity ( p for heterogeneity = 0.37, I 2 = 0%, Figure 5E ).…”

Section: Resultsmentioning

confidence: 99%

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Risk factors for distal junctional kyphosis after posterior spinal surgery in adolescent idiopathic scoliosis: a meta-analysis

Jia,

Long

2023

Front. Surg.

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“…Fusions with LIV proximal to the sagittal stable vertebrae (SSV, caudal vertebrae touched by the vertical line from posterior corner of S1) have notable risk of developing DJK. 17,19 Yang et al 16 demonstrated the importance of including the SSV in the instrumentation by demonstrating an incidence of DJK of zero for patients with LIV at or below the SSV, as opposed to 17% for those with LIV above the SSV. Thus, it is imperative to avoid making preoperative decisions based solely on coronal images.…”

Section: Early Iatrogenic Sequelae Of Sagittal Malalignmentmentioning

confidence: 99%

“…3,28 More specific recommendations have arisen reminding surgeons to include the SSV in the LIV when possible because failing to do so markedly increases the likelihood for DJF. 16,17,19 In addition, in the setting of a selective thoracic fusion of a Lenke 1 curve, instrumenting the UIV caudal to the upper end vertebrae markedly increases the likelihood of PJK, whereas in the setting of selective thoracolumbar/lumbar fusion of a Lenke 5 curve, instrumenting the UIV cephalad to the upper end vertebrae markedly increases the likelihood of PJK. 12…”

Section: Surgical Considerations To Optimize Restoration Of Thoracic ...mentioning

confidence: 99%

The Sagittal Plane in Spinal Fusion for Adolescent Idiopathic Scoliosis

Ritzman

Floccari

2022

J Am Acad Orthop Surg

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Sagittal balance is widely recognized as the primary determinant of optimal outcomes in adult spinal deformity. In adolescent idiopathic scoliosis (AIS), coronal correction risks being obtained at the expense of sagittal malalignment after posterior spinal fusion. Apical lordosis, often underestimated on two-dimensional imaging, is the primary deforming factor in AIS. Failure to restore thoracic kyphosis and lumbar lordosis during posterior spinal fusion contributes to problematic early surgical complications, including proximal or distal junctional kyphosis and failure. Although adolescent patients often compensate for sagittal imbalance in the short-term and mid-term, late sequelae of iatrogenic sagittal imbalance include flatback syndrome, disk degeneration, cervical kyphosis, and late decompensation. Objective criteria using spinopelvic parameters and preoperative three-dimensional planning can guide sagittal plane correction during PSF for AIS. Technical caveats can help avoid sagittal plane complications, including instrumentation level selection, anchor type, and anatomic protection of adjacent levels. Other surgical techniques to optimize restoration of thoracic kyphosis include higher implant density, stiffer rod material, Ponte osteotomies, and deformity correction technique.

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Defining “successful” treatment outcomes in adolescent idiopathic scoliosis: a scoping review

Joarder

Taniguchi

Mendoza³

et al. 2023

Eur Spine J

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Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis that affects children aged 10 to 18 years old, manifesting in a three dimensional spinal deformity. This study aimed to explore outcome measures used in de ning AIS treatment success. Particularly, analyzing the extent of radiographic and quality of life domains used and whether AIS treatment approaches (surgical, bracing, physiotherapy etc.) in uences outcomes used as proxies of treatment success. MethodsEMBASE and MEDLINE databases were used to conduct a systematic scoping review with 158 papers screened for data extraction. Extractable variables included: study characteristics, study participant characteristics, type of study, type of intervention approach and outcome measures. ResultsAll 158 studies measured quantitative outcomes. 61.38% of papers used radiographic outcomes whilst 38.62% of papers used quantitative quality of life outcomes to evaluate treatment success. Irrespective of treatment intervention utilized, the type of quantitative outcome measure recorded did not differ signi cantly. Moreover, of the radiographic outcome measures, the subcategory Cobb angle was predominantly used across all intervention approaches. For quantitative quality of life measures, questionnaires investigating multiple domains such as SRS were primarily used as proxies of AIS treatment success across all intervention approaches. ConclusionThis study identi ed that no articles employed qualitative measures of describing the psychosocial implications of AIS in de ning treatment success. Although quantitative measures have merit in clinical diagnoses and management, there is increasing value in using qualitative methods such as thematic analysis in guiding clinicians to develop a biopsychosocial approach for patient care.

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Including the stable sagittal vertebra in the fusion for adolescent idiopathic scoliosis reduces the risk of distal junctional kyphosis in Lenke 1–3 B and C curves

Cited by 8 publications

References 25 publications

Risk factors for distal junctional kyphosis after posterior spinal surgery in adolescent idiopathic scoliosis: a meta-analysis

Risk factors for distal junctional kyphosis after posterior spinal surgery in adolescent idiopathic scoliosis: a meta-analysis

The Sagittal Plane in Spinal Fusion for Adolescent Idiopathic Scoliosis

Defining “successful” treatment outcomes in adolescent idiopathic scoliosis: a scoping review

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