Long-Term Anatomic and Functional Changes in Patients With Adolescent Idiopathic Scoliosis Treated by Harrington Rod Fusion

Cochran, Thomas; Irstam, Lars; Nachemson, Alf

doi:10.1097/01241398-198403000-00064

Cited by 45 publications

(70 citation statements)

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“…Lateral roentgenograms demonstrated that the 52% of patients with flattened or kyphotic cervical spines had no significant complaint, nonsignificant flattening of the thoracic kyphosis, but significant lowering of the lumbar lordosis [9]. In 1995, Hilibrand et al published a radiographic study on the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis.…”

Section: Discussionmentioning

confidence: 99%

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Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

et al. 2011

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The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior-posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0°± 12.3°(range -30°to 40°) of lordosis. Postoperatively, the average CSA was 1.7°± 11.4°(range -24°to 30°). After surgery, it was less than 20°in 27 patients (84.4%) and between 20°and 40°in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.

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Section: Discussionmentioning

confidence: 99%

“…The sagittal profile often deteriorates when the Harrington technique is used. The consequences include a flat back, an angular increase of lumbar lordosis below the fusion level and low back pain [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

et al. 2011

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“…Cochran et al [1] subjectively observed a cervical flattening or kyphosis in 49/95 patients without measurement. Hilibrand et al [2] reported a straight (lordosis \5°) or kyphotic cervical alignment in 34/39 patients (89 %) and concluded that patients with idiopathic scoliosis developed lordosis within thoracic spine and compensatory kyphosis within the cervical and lumbar segments.…”

Section: Cervico-thoracic Curves In Different Groupsmentioning

confidence: 99%

“…The discussion about cervical kyphosis in idiopathic scoliosis has lasted for over three decades [1]. Hilibrand et al [2] reported a result of 6°of kyphosis for cervical spine and a phenomenon that a hypo-kyphotic thoracic spine accompanies a kyphotic cervical spine before operation.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases

Silvestre

Mouton

et al. 2013

Eur Spine J

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Purpose To analyze the relationship between the cervical spine and global spinal-pelvic alignment in young patients with idiopathic scoliosis based on a morphological classification, and to postulate the hypothesis that cervical kyphosis is a part of cervico-thoracic kyphosis in them. Methods 120 young patients with idiopathic scoliosis were recruited retrospectively between 2006 and 2011. The following values were measured and calculated: cervical angles (CA), cervico-thoracic angles (CTA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), spinal sacral angle (SSA), hip to C7/hip to sacrum, thoracic kyphosis (TK), lumbar lordosis (LL), Roussouly sagittal classification, Lenke Type Curve and Lumbar Modifier. The cervical curves were classified as lordosis, straight, sigmoid and kyphosis. They were categorized into four groups as cervical non-kyphosis group (CNK Group), cervical kyphosis group (CK Group), cervical-middle-thoracic kyphosis group (CMTK Group), and cervical-lower-thoracic kyphosis group (CLTK Group) according to their morphological characters of sagittal alignments. All parameters were compared and analyzed among groups. Results The incidence of cervical kyphosis was 40 % (48/ 120). The CA and the CTA were in significant correlation (r = 0.854, P = 0.00). The cervical spine alignments were revealed to be significantly different among groups (r = 85.04, P = 0.00). Significant differences among groups in CA, CTA and TK were also detected. A strong correlation between the group type and Lenke Lumbar Modifier was still seen (P \ 0.05). Fisher's exact test revealed that the individual vertebral body kyphosis and wedging were directly related to the overall cervical kyphosis (P = 0.00, respectively). Conclusion The cervical kyphosis is correlated with global sagittal alignment, and is a part of cervico-thoracic sagittal deformity in young patients with idiopathic scoliosis. Despite the deformity in cervical alignment, the global spine could still be well-balanced with spontaneous adjustment. The correlation between our grouping based on the morphological characteristics of the sagittal alignments and Lenke Lumbar Modifier suggests that the coupled motion principle be appropriate to explain the modifications both in coronal and sagittal planes.

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“…The patients were not allowed to attend school for the initial 6 postoperative months and were advised either to have teaching at home or to repeat a year in school. The detailed treatment protocol has been described in an earlier study with a shorter (7-10 years) follow-up [9,10] and the radiographic and clinical results from the present follow-up are presented in a separate article [14].…”

Section: Patientsmentioning

confidence: 99%

Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery

et al. 2001

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No results on long-term outcome in terms of health-related quality of life (HRQL) have previously been presented for patients treated for adolescent idiopathic scoliosis. A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before the age of 21, either with distraction and fusion using Harrington rods [surgical treatment group (ST), n=156; 145 females and 11 males] or with a brace [brace treatment group (BT), n=127; 122 females and 5 males] were followed at least 20 years after completion of the treatment. Ninety-four percent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnaire, parts of SRS/MODEM'S questionnaire and study-specific questions concerning the treatment, as a part of an unbiased personal follow-up examination including radiography and clinical examination. An age-and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. The results showed no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but significantly, reduced physical function using the SF-36 subscales, SF-36/Physical Component Summary (PCS) score as well as the Oswestry Disability Back Pain Questionnaire compared to the controls. Neither the mental subscales and the Mental Component Summary (MCS) score of SF-36 nor the PGWB index showed any significant difference between the groups. Forty-nine percent of ST, 34% of BT and 15% of controls admitted limitation of social activities due to their back [P<0.001 ST vs controls, P=0.0010 BT vs controls, and n.s. (P=0.024) ST vs BT], mostly due to difficulties with physical participation in activities or selfconsciousness about appearance. Pain was a minor reason for limitation. No correlation was found between the outcome scores and curve size after treatment, curve type, total treatment time or age at completed treatment. Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population. A minority of the patients (4%) had a severely decreased psychological well-being, and a few (1.5%) were severely physically disabled due to the back.

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Long-Term Anatomic and Functional Changes in Patients With Adolescent Idiopathic Scoliosis Treated by Harrington Rod Fusion

Cited by 45 publications

References 0 publications

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases

Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery

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