Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve

Sudo, Hideki; Abe, Yuichiro; Abumi, Kuniyoshi; Iwasaki, Norimasa; Ito, Manabu

doi:10.1007/s00586-015-4139-z

Cited by 18 publications

(27 citation statements)

References 27 publications

(71 reference statements)

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“…Coronal and sagittal Cobb angle measurements of the main thoracic (MT) curves were obtained. The end vertebrae levels were determined on preoperative radiographs and measured on subsequent radiographs to maintain consistency for statistical comparisons [7,8]. Sagittal measurements included the TK (T5–T12) angle [7,8].…”

Section: Methodsmentioning

confidence: 99%

“…The end vertebrae levels were determined on preoperative radiographs and measured on subsequent radiographs to maintain consistency for statistical comparisons [7,8]. Sagittal measurements included the TK (T5–T12) angle [7,8]. The number of facetectomy levels was counted, and screw density was expressed as the number of screws per level instrumented for each patient.…”

Section: Methodsmentioning

confidence: 99%

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Effects of Multilevel Facetectomy and Screw Density on Postoperative Changes in Spinal Rod Contour in Thoracic Adolescent Idiopathic Scoliosis Surgery

et al. 2016

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Flattening of the preimplantation rod contour in the sagittal plane influences thoracic kyphosis (TK) restoration in adolescent idiopathic scoliosis (AIS) surgery. The effects of multilevel facetectomy and screw density on postoperative changes in spinal rod contour have not been documented. This study aimed to evaluate the effects of multilevel facetectomy and screw density on changes in spinal rod contour from before implantation to after surgical correction of thoracic curves in patients with AIS prospectively. The concave and convex rod shapes from patients with thoracic AIS (n = 49) were traced prior to insertion. Postoperative sagittal rod shape was determined by computed tomography. The angle of intersection of the tangents to the rod end points was measured. Multiple stepwise linear regression analysis was used to identify variables independently predictive of change in rod contour (Δθ). Average Δθ at the concave and convex side were 13.6° ± 7.5° and 4.3° ± 4.8°, respectively. The Δθ at the concave side was significantly greater than that of the convex side (P < 0.0001) and significantly correlated with Risser sign (P = 0.032), the preoperative main thoracic Cobb angle (P = 0.031), the preoperative TK angle (P = 0.012), and the number of facetectomy levels (P = 0.007). Furthermore, a Δθ at the concave side ≥14° significantly correlated with the postoperative TK angle (P = 0.003), the number of facetectomy levels (P = 0.021), and screw density at the concave side (P = 0.008). Rod deformation at the concave side suggests that corrective forces acting on that side are greater than on the convex side. Multilevel facetectomy and/or screw density at the concave side have positive effects on reducing the rod deformation that can lead to a loss of TK angle postoperatively.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effects of Multilevel Facetectomy and Screw Density on Postoperative Changes in Spinal Rod Contour in Thoracic Adolescent Idiopathic Scoliosis Surgery

et al. 2016

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“…The LIV rotation angle was measured on CT scans before and immediately after surgery. [10][11][12] The angles of vertebral rotation were measured with reference to the junction of the laminae, the dorsal central aspect of the vertebral foramen, the middle of the vertebral body, and the sagittal plane. [10][11][12] LIV rotation was defined as positive (+) or negative (-) when the rotation relative to the pelvis was clockwise or counterclockwise, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…The bending radiographs were obtained from supine anteroposterior passive bending radiographs. The instrumentation levels were determined from end-to-end vertebrae on standing radiographs in most cases, and vertebrae without rotation on the bending films were selected as the LIV, 10,12,13 except for the following cases: when the distance between the geometrical center of the upper end vertebra (UEV) and the C7 plumb line was > 20 mm, a UIV one level above the UEV was selected regardless of shoulder balance for the Lenke 1 curves. When the UEV was T1 for the Lenke 2 curves, T2 was selected as the UIV.…”

Section: Surgical Techniquementioning

confidence: 99%

Impact of lowest instrumented vertebra tilt and rotation on uninstrumented lumbar curve and L4 tilt in thoracic adolescent idiopathic scoliosis

Iwata

Sudo

Abumi

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEControversy exists regarding the effects of lowest instrumented vertebra (LIV) tilt and rotation on uninstrumented lumbar segments in adolescent idiopathic scoliosis (AIS) surgery. Because the intraoperative LIV tilt from the inferior endplate of the LIV to the superior sacral endplate is not stable after surgery, the authors measured the LIV angle of the instrumented thoracic spine as the LIV angle of the construct. This study aimed to evaluate the effects of the LIV angle of the construct and the effects of LIV rotation on the postoperative uninstrumented lumbar curve and L4 tilt in patients with thoracic AIS.METHODSA retrospective correlation and multivariate analysis of a prospectively collected, consecutive, nonrandomized series of patients at a single institution was undertaken. Eighty consecutive patients with Lenke type 1 or type 2 AIS treated with posterior correction and fusion were included. Preoperative and 2-year postoperative radiographic measurements were the outcome measures for this study. Outcome variables were postoperative uninstrumented lumbar segments (LIV tilt, LIV translation, uninstrumented lumbar curve, thoracolumbar/lumbar [TL/L] apical vertebral translation [AVT], and L4 tilt). The LIV angle of the construct was measured from the orthogonal line drawn from the upper instrumented vertebra to the LIV. Multiple stepwise linear regression analysis was conducted between outcome variables and patient demographics/radiographic measurements. There were no study-specific biases related to conflicts of interest.RESULTSPredictor variables for postoperative uninstrumented lumbar curve were the postoperative LIV angle of the construct, number of uninstrumented lumbar segments, and flexibility of TL/L curve. Specifically, a lower postoperative uninstrumented lumbar curve was predicted by a lower absolute value of the postoperative LIV angle of the construct (p < 0.0001). Predictor variables for postoperative L4 tilt were postoperative LIV rotation, preoperative L4 tilt, and preoperative uninstrumented lumbar curve. Specifically, a lower postoperative L4 tilt was predicted by a lower absolute value of postoperative LIV rotation (p < 0.0001).CONCLUSIONSThe LIV angle of the construct significantly affected the LIV tilt, uninstrumented lumbar curve, and TL/L AVT. LIV rotation significantly affected the LIV translation and L4 tilt.

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“…Similar to the single curve, the cranial apex was created. After connecting the two rods to all screw heads, the two rods were simultaneously rotated . An in situ rod bending maneuver was not conducted during the surgery.…”

Section: Methodsmentioning

confidence: 99%

Identification of optimized rod shapes to guide anatomical spinal reconstruction for adolescent thoracic idiopathic scoliosis

Kokabu

Kanai

Abe

et al. 2018

Journal Orthopaedic Research

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Adolescent idiopathic scoliosis (AIS), the most common pediatric musculoskeletal disorder, causes a three-dimensional deformity of the spine. Although rod curvature could play an important role in anatomical spinal reconstruction in patients with thoracic AIS, intraoperative contouring of the straight rod induces notches into the rod, leading to decreased fatigue strength. Here, we analyzed pre-bent rod geometries from 46 intraoperative tracings of the rod geometry, which can provide anatomical spinal reconstruction in patients with thoracic AIS. The center point clouds of the rod shapes were extracted and approximated as arcs and straight lines. The difference between the center point clouds were evaluated using the iterative closest point methods. When the rod shapes were divided into six groups based on length followed by hierarchical cluster analysis, 10 representative rod shapes were obtained with a difference value of 5 mm. Thus, we identified optimized rod shapes to guide anatomical spinal reconstruction for thoracic AIS, which will reduce not only the risk of rod breakage but also operation time, leading to decreased patient burden. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve

Abstract: Radiographic findings and patient outcomes were satisfactory. Thoracic kyphosis can be maintained or improved, while coronal and axial deformities can be corrected using SDRRT for Lenke 2 AIS with a rigid PT curve.

Cited by 18 publications

References 27 publications

Effects of Multilevel Facetectomy and Screw Density on Postoperative Changes in Spinal Rod Contour in Thoracic Adolescent Idiopathic Scoliosis Surgery

Effects of Multilevel Facetectomy and Screw Density on Postoperative Changes in Spinal Rod Contour in Thoracic Adolescent Idiopathic Scoliosis Surgery

Impact of lowest instrumented vertebra tilt and rotation on uninstrumented lumbar curve and L4 tilt in thoracic adolescent idiopathic scoliosis

Identification of optimized rod shapes to guide anatomical spinal reconstruction for adolescent thoracic idiopathic scoliosis

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