Pain and Disability Determine Treatment Modality for Older Patients With Adult Scoliosis, While Deformity Guides Treatment for Younger Patients

Bess, Shay; Boachie-Adjei, Oheneba; Burton, Doug; Cunningham, Matthew E.; Shaffrey, Chris; Shelokov, Alexis; Hostin, Richard A.; Schwab, Frank J.; Wood, Kirkham B.; Akbarnia, Behrooz A.

doi:10.1097/brs.0b013e3181b05146

Cited by 177 publications

(91 citation statements)

References 16 publications

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“…Surgical management of Adolescent Idiopathic scoliosis (AIS) remains controversial, particularly regarding optimal posterior fusion strategy [1,2]. 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

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…6,21,22 Although coronal plane correction also has clinical relevance, sagittal corrections appear to have greater importance, 5,6 principally because sagittal radiographic parameters have consistently been associated with physical disability, emotional disability, and diminished health-related quality of life. 2,5,6,10,13,20,23,26 Sagittal cervical malalignment merits proper consideration since it has been associated with significantly worse patient outcomes. In a recent cohort study of 113 patients, Tang et al demonstrated that cervical malalignment correlates with physical disability.…”

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confidence: 99%

Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up

Scheer

Eastlack

et al. 2015

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OBJECT Alignment changes in the cervical spine that occur following surgical correction for thoracic deformity remain poorly understood. The purpose of this study was to evaluate such changes in a cohort of adults with thoracic deformity treated surgically. METHODS The authors conducted a multicenter retrospective analysis of consecutive patients with thoracic deformity. Inclusion criteria for this study were as follows: corrective osteotomy for thoracic deformity, upper-most instrumented vertebra (UIV) between T-1 and T-4, lower-most instrumented vertebra (LIV) at or above L-5 (LIV ≥ L-5) or at the ilium (LIV-ilium), and a minimum radiographic follow-up of 2 years. Sagittal radiographic parameters were assessed preoperatively as well as at 3 months and 2 years postoperatively, including the C-7 sagittal vertical axis (SVA), C2–7 cervical lordosis (CL), C2–7 SVA, T-1 slope (T1S), T1S minus CL (T1S-CL), T2–12 thoracic kyphosis (TK), apical TK, lumbar lordosis (LL), pelvic incidence (PI), PI-LL, pelvic tilt (PT), and sacral slope (SS). RESULTS Fifty-seven patients with a mean age of 49.1 ± 14.6 years met the study inclusion criteria. The preoperative prevalence of increased CL (CL > 15°) was 48.9%. Both 3-month and 2-year apical TK improved from baseline (p < 0.05, statistically significant). At the 2-year follow-up, only the C2–7 SVA increased significantly from baseline (p = 0.01), whereas LL decreased from baseline (p < 0.01). The prevalence of increased CL was 35.3% at 3 months and 47.8% at 2 years, which did not represent a significant change. Postoperative cervical alignment changes were not significantly different from preoperative values regardless of the LIV (LIV ≥ L-5 or LIV-ilium, p > 0.05 for both). In a subset of patients with a maximum TK ≥ 60° (35 patients) and 3-column osteotomy (38 patients), no significant postoperative cervical changes were seen. CONCLUSION Increased CL is common in adult spinal deformity patients with thoracic deformities and, unlike after lumbar corrective surgery, does not appear to normalize after thoracic corrective surgery. Cervical sagittal malalignment (C2–7 SVA) also increases postoperatively. Surgeons should be aware that spontaneous cervical alignment normalization might not occur following thoracic deformity correction.

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“…Corticosteroid injections in the form of nerve root blocks, facet injections and epidural steroid injections may be of considerable value in the arsenal of conservative management [8]. Only after the failure of a minimum 6 months conservative treatment, if disability and pain scores haven't decreased, the surgical option will be considered and discussed with the patient [20].…”

Section: Mechanical Failurementioning

confidence: 99%

Adult Scoliosis: A Retrospective Analysis of the Correlation between Radiological Parameters and Clinical Outcomes

Bròdano¹,

Babbi²,

Girolami³

et al. 2015

J Spine

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Pain and Disability Determine Treatment Modality for Older Patients With Adult Scoliosis, While Deformity Guides Treatment for Younger Patients

Cited by 177 publications

References 16 publications

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

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

Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up

Adult Scoliosis: A Retrospective Analysis of the Correlation between Radiological Parameters and Clinical Outcomes

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