Taking the shoulders and pelvis into account in the preoperative classification of idiopathic scoliosis in adolescents and young adults (a constructive critique of King’s and Lenke’s systems of classification)

Bergoin, M; Gennari, Jean-Marie; Jean-Michel, Tallet

doi:10.1007/s00586-011-1899-y

Cited by 19 publications

(4 citation statements)

References 26 publications

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Section: Discussionmentioning

confidence: 99%

“…When the discrepancy is >2 cm, the radiograph should be performed with the presence of a shoe lift. 9 However, in both classification, the pelvis was not included as part of the classification, which was the subject of the critique by Maurice et al 10 Asymmetry of pelvic morphology is often encountered in erect anteroposterior whole spine radiograph in AIS patients. The pelvic axial rotation has been investigated by many authors.…”

Section: Discussionmentioning

confidence: 99%

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Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: A preoperative analysis of 311 lower limb axis films

Chan

Naing

Chiu

et al. 2019

J Orthop Surg (Hong Kong)

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To analyze the incidence, pattern, and contributing factors of pelvic obliquity among Adolescent Idiopathic Scoliosis (AIS) patients who will undergo surgery. Methods: In total, 311 patients underwent erect whole spine anteroposterior, lateral and lower limb axis films. Radiographic measurements included Transilium Pelvic Height Difference (TPHD; mm), Hip Abduction-Adduction angle (H/Abd-Add;), Lower limb Length Discrepancy (LLD; mm), and Pelvic Hypoplasia (PH angle;). The incidence and severity of pelvic obliquity were stratified to Lenke curve subtypes in 311 patients. The causes of pelvic obliquity were analyzed in 57 patients with TPHD !10 mm. Results: The mean Cobb angle was 64.0 + 17.2. Sixty-nine patients had a TPHD of 0 mm (22.2%). The TPHD was <5 mm in 134 (43.0%) patients, 5-9 mm in 104 (33.4%) patients, 10-14 mm in 52 (16.7%) patients, 15-19 mm in 19 (6.1%) patients, and !20 mm in only 2 (0.6%) patients. There was a significant difference between the Lenke curve types in terms of TPHD (p ¼ 0.002). L6 curve types had the highest TPHD of 9.0 + 6.3 mm followed by L5 curves, which had a TPHD of 7.1 + 4.8 mm. In all, 44.2% of L1 curves and 50.0% of L2 curves had positive TPHD compared to 66.7% of L5 curves and 74.1% of L6 curves which had negative TPHD. 33.3% and 24.6% of pelvic obliquity were attributed to PH and LLD, respectively, whereas 10.5% of cases were attributed to H/Abd-Add positioning. Conclusions: 76.4% of AIS cases had pelvic obliquity <10 mm; 44.2% of L1 curves and 50.0% of L2 curves had a lower right hemipelvis compared to 66.7% of L5 curves and 74.1% of L6 curves, which had a higher right hemipelvis. Among patients with pelvic obliquity !10 mm, 33.3% were attributed to PH, whereas 24.6% were attributed to LLD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: A preoperative analysis of 311 lower limb axis films

Chan

Naing

Chiu

et al. 2019

J Orthop Surg (Hong Kong)

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“…The present study supports these observations but also adds to these results on pelvic morphology abnormalities. The latter is an important factor related to the Cobb angle progression [3] and can involve the lumbar curve [33]. Though Stylianides et al [3] reported pelvic morphology in both able-bodied and scoliotic girls and that sagittal spinopelvic balance was analyzed in non-scoliotic [34] and AIS subjects [35], no one has related it to body posture and standing balance yet.…”

Section: Discussionmentioning

confidence: 99%

Pelvic Morphology, Body Posture and Standing Balance Characteristics of Adolescent Able-Bodied and Idiopathic Scoliosis Girls

Stylianides

Dalleau²,

Begon

et al. 2013

PLoS ONE

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The purpose of this study was to determine how pelvic morphology, body posture, and standing balance variables of scoliotic girls differ from those of able-bodied girls, and to classify neuro-biomechanical variables in terms of a lower number of unobserved variables. Twenty-eight scoliotic and twenty-five non-scoliotic able-bodied girls participated in this study. 3D coordinates of ten anatomic body landmarks were used to describe pelvic morphology and trunk posture using a Flock of Birds system. Standing balance was measured using a force plate to identify the center of pressure (COP), and its anteroposterior (AP) and mediolateral (ML) displacements. A multivariate analysis of variance (MANOVA) was performed to determine differences between the two groups. A factor analysis was used to identify factors that best describe both groups. Statistical differences were identified between the groups for each of the parameter types. While spatial orientation of the pelvis was similar in both groups, five of the eight trunk postural variables of the scoliotic group were significantly different that the able-bodied group. Also, five out of the seven standing balance variables were higher in the scoliotic girls. Approximately 60% of the variation is supported by 4 factors that can be associated with a set of variables; standing balance variables (factor 1), body posture variables (factor 2), and pelvic morphology variables (factors 3 and 4). Pelvic distortion, body posture asymmetry, and standing imbalance are more pronounced in scoliotic girls, when compared to able-bodied girls. These findings may be beneficial when addressing balance and ankle proprioception exercises for the scoliotic population.

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“…Proximally, the primary concern is to select the level that will achieve maximum deformity correction and fulfill well-balanced shoulders. 16 Lenke's classification recommended fusion of the structural proximal thoracic curve. 7,14 The correction of the main thoracic curve while leaving a structural upper thoracic curve may lead to postoperative clinical shoulder imbalance.…”

Section: In 2001mentioning

confidence: 99%

Shoulder Balance and Scoliosis: The Unresolved Issue

Sorour

Elbanna

Samy

2019

Egyptian Spine Journal

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Background Data: The main indication of surgery in patients with AIS is better function and cosmesis. Shoulder balance should be considered amongst cosmetic parameters that are strongly associated with patient satisfaction after surgery in patients with AIS. Proper correction of the main and proximal thoracic curves in conjunction with horizontalization of upper instrumented vertebra (UIV) is supposed to promote shoulder balance. In other words, better correction of radiological parameters should promote clinical shoulder balance; however, this is not always observed. Purpose: Determining which of the following radiological measures correlate significantly with postoperative clinical shoulder balance: T1 tilt, UIV tilt, clavicle rib intersection angle, and degree of proximal thoracic curve correction. Study Design: Retrospective clinical case cohort study. Patients and Methods: The study included 20 patients of AIS operated for correction by pedicle screw instrumentation. There were 13 females and 7 males. The mean age at the time of surgery was 14±2.4 years with a range from 11 to 18 years. Mean preoperative Cobb angle of the major curve was 76.1±21.7° corrected to a mean postoperative Cobb 28.2±14.2°. Correction percentage of the major curve was 63.1±14.2%. The data obtained from high resolution back view photographs (to assess clinical shoulder balance) and whole spine X-ray films taken within the first year of follow-up period (to assess radiological measures related to shoulder balance) were retrospectively evaluated. Outcome measures: clinical shoulder balance was correlated with 4 radiological parameters, namely, proximal thoracic curve correction percentage, T1 tilt, UIV tilt, and clavicle-rib intersection angle. Measurements were done by Surgimap software version 2.2.12 (Nemaris, Inc.,US, https://www.surgimap.com). Results: A weak positive correlation was found between postoperative shoulder balance and UIV tilt (r)=0.242, P=0.305, and a very weak negative correlation was found between postoperative shoulder balance and proximal thoracic curve correction percentage (r)=-0.027, P=0.910. A moderate positive correlation but statistically nonsignificant was found between postoperative shoulder balance and T1 tilt (r)=0.440, P=0.052, and a statistically significant positive correlation was found between shoulder balance and clavicle rib intersection angle (r)=0.567, P=0.009.

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Taking the shoulders and pelvis into account in the preoperative classification of idiopathic scoliosis in adolescents and young adults (a constructive critique of King’s and Lenke’s systems of classification)

Cited by 19 publications

References 26 publications

Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: A preoperative analysis of 311 lower limb axis films

Pelvic obliquity in adolescent idiopathic scoliosis planned for posterior spinal fusion: A preoperative analysis of 311 lower limb axis films

Pelvic Morphology, Body Posture and Standing Balance Characteristics of Adolescent Able-Bodied and Idiopathic Scoliosis Girls

Shoulder Balance and Scoliosis: The Unresolved Issue

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