Junctional kyphosis after the treatment of adolescent idiopathic scoliosis
Iranian Journal of Pediatric Surgery,
Vol. 2 No. 1 (2016),
23 August 2016
Introduction: In this retrospective study radiographic review was undertaken in patients treated for AIS (Adolescent Idiopathic Scoliosis), in order to determine the most important preoperative factors that are seen with postoperative junctional kyphosis.
Material &Methods: Sagittal spine profiles were measured on the standing radiographs before surgery, after surgery and in the last follow-up postoperative visit of the patients with AIS. The following parameters were measured on lateral views: lumbar lordosis, thoracic kyphosis, the sagittal offset distance of C7 to a vertical line from postero-superior edge of S1 (Sagittal Vertical Axis-SVA) and T9 sagittal offset angle.
Results: One hundred and twenty patients with a mean 42 months of follow-up (24-112 months) were included in the study. Mean values of the parameters before corrective surgery were: lumbar lordosis 45° ± 13.6°, thoracic kyphosis 28°±18.4°, SVA 35 ± 27.2 mm and T9 offset angle, 7.8°± 5.1°. Mean values at last follow-up were: lumbar lordosis 49± 9.8°, thoracic kyphosis 35 ± 16.4°, SVA 39 ± 24 mm and T9 offset angle, 8.6°±5.8°. There were 10 upper junctional kyphosis (8.4%). T test statistics revealed significant correction of lumbar lordosis and thoracic kyphosis after fusion in all patients (P<0.001, P=0.006 respectively). Preoperative mean of T9 sagittal offset angle was higher in the patients with proximal junctional kyphosis (P=0.006).
Conclusion: Normal sagittal balance of spine is essential for the optimum function of the intervertebral disks and preventing sagittal postoperative complication like proximal junctional kyphosis. More attention to preoperative sagittal parameters of the spine like T9 offset may be important to prevent such complications.
- junctional kyphsis
- adolescent idiopathic scliosis
How to Cite
Lazennec J, Ramare S, Arafati N, Laudet C, Gorin M, Roger B, et al. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. European Spine Journal. 2000;9(1):47-55.
Mac-Thiong J-M, Labelle H, Charlebois M, Huot M-P, de Guise JA. Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine. 2003;28(13):1404-9.
Rajnics P, Pomero V, Templier A, Lavaste F, Illes T. Computer-assisted assessment of spinal sagittal plane radiographs. Journal of Spinal Disorders & Techniques. 2001;14(2):135-42.
Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, et al. Adolescent idiopathic scoliosis. The Journal of Bone & Joint Surgery. 2001;83(8):1169-81.
Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Charles Edwards I. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine. 2005;30(14):1643-9.
Legaye J, Duval-Beaupere G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. European Spine Journal. 1998;7(2):99-103.
Duval-Beaupere G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Annals of biomedical engineering. 1992;20(4):451-62.
Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM. Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine. 1999;24(16):1712.
Lagrone M, Bradford D, Moe J, Lonstein J, Winter R, Ogilvie J. Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg Am. 1988;70(4):569-80.
Charlebois M, Mac-Thiong J-M, Huot M-P, de Guise JA, Skalli W, Labelle H. Relation between the pelvis and the sagittal profile in adolescent idiopathic scoliosis: the influence of curve type. Studies in health technology and informatics. 2001;91:140-3.
Yang S-H, Chen P-Q. Proximal kyphosis after short posterior fusion for thoracolumbar scoliosis. Clinical orthopaedics and related research. 2003;411:152-8.
Lee GA, Betz RR, Clements III DH, Huss GK. Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis. Spine. 1999;24(8):795-9.
Rhee JM, Bridwell KH, Won DS, Lenke LG, Chotigavanichaya C, Hanson DS. Sagittal plane analysis of adolescent idiopathic scoliosis: the effect of anterior versus posterior instrumentation. Spine. 2002;27(21):2350-6.
Kim YJ, Bridwell KH, Lenke LG, Kim J, Cho SK. Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine. 2005;30(18):2045-50.
- Abstract Viewed: 372 times
- PDF Downloaded: 137 times