Thoracic sagittal plane variations between patients with thoracic adolescent idiopathic scoliosis and healthy adolescents

Pizones, Javier; Núñez-Medina, Alberto; Sánchez-Mariscal, Felisa; Zúñiga, Lorenzo; Izquierdo, Enrique

doi:10.1007/s00586-016-4400-0

Cited by 12 publications

(13 citation statements)

References 30 publications

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“…Many previous studies demonstrated the regional flattening of the thoracic sagittal profile on lateral radiographs, as a result of the rotated apical lordosis [18][19][20]. Not all thoracic spines in AIS, however, present as a hypokyphosis on lateral radiographs.…”

Section: Discussionmentioning

confidence: 94%

“…Clément et al noted that approximately half of the primary thoracic curves present as a normokyphosis on lateral radiographs when the regional kyphosis is considered [19]. Also, Pizones et al demonstrated patients with severe AIS were on average more hypokyphotic than healthy adolescents and that double thoracic curves were associated with a high thoracic kyphosis [20]. In many previous studies, however, only severe/preoperative AIS cases were included and the individual variability in concomitant coronal spinal deformation and sagittal alignment was not taken into account.…”

Section: Discussionmentioning

confidence: 99%

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Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

Schlösser

Castelein

Grobost³

et al. 2021

Eur Spine J

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Purpose The complex three-dimensional spinal deformity in AIS consists of rotated, lordotic apical areas and neutral junctional zones that modify the spine’s sagittal profile. Recently, three specific patterns of thoracic sagittal ‘malalignment’ were described for severe AIS. The aim of this study is to define whether specific patterns of pathological sagittal alignment are already present in mild AIS. Methods Lateral spinal radiographs of 192 mild (10°–20°) and 253 severe (> 45°) AIS patients and 156 controls were derived from an international consortium. Kyphosis characteristics (T4–T12 thoracic kyphosis, T10–L2 angle, C7 slope, location of the apex of kyphosis and of the inflection point) and sagittal curve types according to Abelin-Genevois were systematically compared between the three cohorts. Results Even in mild thoracic AIS, already 49% of the curves presented sagittal malalignment, mostly thoracic hypokyphosis, whereas only 13% of the (thoraco) lumbar curves and 6% of the nonscoliosis adolescents were hypokyphotic. In severe AIS, 63% had a sagittal malalignment. Hypokyphosis + thoracolumbar kyphosis occurred more frequently in high-PI and primary lumbar curves, whereas cervicothoracic kyphosis occurred more in double thoracic curves. Conclusions Pathological sagittal patterns are often already present in curves 10°–20°, whereas those are rare in non-scoliotic adolescents. This suggests that sagittal ‘malalignment’ patterns are an integral part of the early pathogenesis of AIS.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

Schlösser

Castelein

Grobost³

et al. 2021

Eur Spine J

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“…Thus, at present it is difficult to distinguish physiological from pathological cervical spine alignments in AIS patients. The known global pathologic effects of scoliosis include a deforming coronal deviation of the spine with a concomitant rotation of vertebrae and a flattening of the sagittal profile [11, 12]. In recent studies of adult patients, it has been shown that sagittal alignment has a strong correlation with health-related quality of life scores [13].…”

Section: Introductionmentioning

confidence: 99%

Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients

et al. 2019

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BackgroundSeveral studies have emphasized the importance of restoring thoracic kyphosis (TK) in the setting of AIS, but very few have discussed changes in cervical spine alignment following surgery. Aim of this study was to evaluate reciprocal cervical alignment change after modification of global and regional thoracolumbar alignment with surgery in the setting of adolescent idiopathic scoliosis (AIS).MethodsBaseline and 2-yrs follow-up radiographs of AIS patients (n = 81) were analysed measuring cervical parameters (upper cervical: C2-C0, McGregor Slope; lower cervical: C2-C7, C2-C7 sagittal vertical axis (SVA), C2-T3, C2-T3SVA, C2-T1Harrison (C2-T1Ha), T1 Slope (T1S)), thoracic, lumbar, pelvic and global alignment parameters. Post-operatively, patients were grouped twice; based on changes in TK and SVA. Cervical alignment was compared between groups. Pearson correlation was conducted to examine the relationship between changes in TK, SVA, and cervical alignment.ResultsStratification by change in TK, revealed significant alteration of lower cervical alignment T1S [p < 0.001]), C2-T3 [p = 0.019], C2-T1Ha [p = 0.043]), but there was no reciprocal change in the upper cervical spine. Stratification by SVA revealed a significant coexisting change in the lower cervical spine (T1S [p < 0.001], C2-C7SVA [p = 0.034], C2-T3 [p = 0.023], C2-T3SVA [p = 0.001]). SVA change was not associated to a change in the upper cervical spine. The correlation analysis showed that with a post-operative increase in TK, the cervical spine became more lordotic. Changes in TK were significantly correlated with: ΔT1S, ΔC2-C7, ΔC2-T3, and ΔC2-T3SVA. Similarly, increased cervical kyphosis was found when SVA was decreased post-operatively. Furthermore, there was a significant correlation between change of SVA and both ΔC2-T3 and ΔC2-T3SVA.ConclusionsIn surgically treated AIS patients, changes in global and regional alignment of the thoracolumbar and cervical spinal segments exhibit interdependence. Thus, surgical planning with regard to sagittal deformity in AIS patients should account for the post-operative impact on cervical alignment.

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“…Thoracic alignment is often cited as being hypo-kyphotic or even lordotic in many cases of AIS [ 11 22 23 ]. A study performed by Pizones et al [ 24 ] analyzed sagittal parameters for AIS patients based on their Lenke curve type and found that in patients with moderate AIS, Lenke type 1 curves exhibited normal thoracic sagittal parameters, whereas type 3 had lower thoracic segmental hypo-kyphosis and type 2 had upper segmental hyper-kyphosis. Sangole et al [ 25 ] even used 3D reconstructions of the spine illustrating that type 1 curves can be broadly divided into normo-kyphotic and hypo-kyphotic group.…”

Section: Discussionmentioning

confidence: 99%

Normal Age-Adjusted Sagittal Spinal Alignment Is Achieved with Surgical Correction in Adolescent Idiopathic Scoliosis

Ramchandran¹,

Foster²,

Sure³

et al. 2017

Asian Spine J

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Study DesignRetrospective analysis.PurposeOur hypothesis is that the surgical correction of adolescent idiopathic scoliosis (AIS) maintains normal sagittal alignment as compared to age-matched normative adolescent population.Overview of LiteratureSagittal spino-pelvic alignment in AIS has been reported, however, whether corrective spinal fusion surgery re-establishes normal alignment remains unverified.MethodsSagittal profiles and spino-pelvic parameters of thirty-eight postsurgical correction AIS patients ≤21 years old without prior fusion from a single institution database were compared to previously published normative age-matched data. Coronal and sagittal measurements including structural coronal Cobb angle, pelvic incidence, pelvic tilt, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, C2–C7 cervical lordosis, C2–C7 sagittal vertical axis, and T1 pelvic angles were measured on standing full-body stereoradiographs using validated software to compare preoperative and 6 months postoperative changes with previously published adolescent norms. A sub-group analysis of patients with type 1 Lenke curves was performed comparing preoperative to postoperative alignment and also comparing this with previously published normative values.ResultsThe mean coronal curve of the 38 AIS patients (mean age, 16±2.2 years; 76.3% female) was corrected from 53.6° to 9.6° (80.9%, p<0.01). None of the thoracic and spino-pelvic sagittal parameters changed significantly after surgery in previously hypo- and normo-kyphotic patients. In hyper-kyphotic patients, thoracic kyphosis decreased (p=0.003) with a reciprocal decrease in lumbar lordosis (p=0.01), thus lowering pelvic incidence-lumbar lordosis mismatch mismatch (p=0.009). Structural thoracic scoliosis patients had slightly more thoracic kyphosis than age-matched patients at baseline and surgical correction of the coronal plane of their scoliosis preserved normal sagittal alignment postoperatively. A sub-analysis of Lenke curve type 1 patients (n=24) demonstrated no statistically significant changes in the sagittal alignment postoperatively despite adequate coronal correction.ConclusionsSurgical correction of the coronal plane in AIS patients preserves sagittal and spino-pelvic alignment as compared to age-matched asymptomatic adolescents.

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Thoracic sagittal plane variations between patients with thoracic adolescent idiopathic scoliosis and healthy adolescents

Cited by 12 publications

References 30 publications

Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients

Normal Age-Adjusted Sagittal Spinal Alignment Is Achieved with Surgical Correction in Adolescent Idiopathic Scoliosis

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