Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography

Cui, Guanyu; Watanabe, Kota; Nishiwaki, Yuji; Hosogane, Naobumi; Tsuji, Takashi; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Chiba, Kazuhiro; Matsumoto, Morio

doi:10.1007/s00586-012-2274-3

Cited by 26 publications

(24 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the letter, Dr. Gardner commented that the correction loss in Cobb angle should be less significance, since the value was within the range of error based on the previous reports [1][2][3][4]. In our study, the mean correction loss between the Cobb angle of immediate after surgery and that of postoperative 2 years was 2.5 ± 1.58 [5]. The loss was significant when analyzed using paired t test.…”

supporting

confidence: 55%

See 1 more Smart Citation

Answer to the Letter to the Editor of A. Gardner concerning “Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography” (by G. Cui, K. Watanabe, Y. Nishiwaki, N. Hosogane, T. Tsuji, K. Ishii, M. Nakamura, Y. Toyama, K. Chiba, M. Matsumoto; Eur Spine J (2012) Jun;21(6):1111–20. doi:10.1007/s00586-012-2633-0)

Watanabe

2013

Eur Spine J

View full text Add to dashboard Cite

Cobb angle of immediate after surgery and that of postoperative 2 years was 2.5 ± 1.58 [5]. The loss was significant when analyzed using paired t test. However, the change had no clinical impact when evaluated by SRS-22 scores. Based on our previous study, the coefficient of variations for intra-observer measurement was 2.3 % for the MT curve [6] using a digital measurement software on appropriately adjusted X-ray films [7,8], and by selecting the same end vertebra in each patient at different time course [9]. In this study, we also used CT scans to demonstrate the correction loss in the axial plane and, in doing so, we tried to minimize measurement errors caused by patient positioning during CT examination using the relative AVR (rAVR), which was defined as the difference between the axial rotation angle of the upper instrumented vertebra and the apical vertebra. As a result, we also found a small but significant time-interval difference in rAVR.As Dr. Gardner mentioned, some error will occur at the time of taking X-ray caused by positioning of the trunks, which is somewhat unavoidable. However, combining the results of radiographic and CT measurements, we can conclude that some correction loss may occur even if we use biomechanically stable pedicle screw constructs for adolescent idiopathic scoliosis. Although this small correction loss does not have significant clinical impact, we should be aware of this phenomenon.Acknowledgments Finally, we would like to appreciate to Dr. Gardner for his comments again.

show abstract

supporting

confidence: 55%

“…

Cobb angle of immediate after surgery and that of postoperative 2 years was 2.5 ± 1.58 [5]. The loss was significant when analyzed using paired t test.

…”

mentioning

confidence: 89%

Answer to the Letter to the Editor of A. Gardner concerning “Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography” (by G. Cui, K. Watanabe, Y. Nishiwaki, N. Hosogane, T. Tsuji, K. Ishii, M. Nakamura, Y. Toyama, K. Chiba, M. Matsumoto; Eur Spine J (2012) Jun;21(6):1111–20. doi:10.1007/s00586-012-2633-0)

Watanabe

2013

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…While the presence of a thoracic hyperkyphosis has been correlated with a decrease of clinical outcomes (SRS-score) [34], no modifications of clinical outcomes has been reported at 2-year follow-up in AIS patients with a postoperative hypokyphosis [4]. However, the lack of differences at short-term follow-up does not indicate the long-term prognosis for these patients.…”

Section: Reciprocal Sagittal Interactions and Correlationsmentioning

confidence: 99%

“…However, consensus appears to exist in the necessity to restore a global spinal alignment in the sagittal plane while correcting the thoracic hypokyphosis [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

et al. 2012

View full text Add to dashboard Cite

Purpose Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS. Methods Thirty consecutive adolescents (mean age 14.6 years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2 year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24 months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (CL2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient. Results Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6°vs. 17.2°, p \ 0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7°vs. 26.2°, p \ 0.005) was noted, without difference between 3 and 24 months postoperatively. An improvement in lumbar lordosis, LL (43.9°vs. 47.3°, p = 0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL (R = 0.382, p = 0.037), without correlation between these reciprocal changes and the amount of coronal correction. Conclusion Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3 months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.

show abstract

“…I wish to raise with you a concern about the methodology and interpretation of results from the recent paper 'Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography' by G. Cui and co-workers [1].…”

mentioning

confidence: 99%