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Article: Coupling between sagittal and frontal plane deformity correction in idiopathic thoracic scoliosis and its relationship with postoperative sagittal alignment

TitleCoupling between sagittal and frontal plane deformity correction in idiopathic thoracic scoliosis and its relationship with postoperative sagittal alignment
Authors
KeywordsAdolescent idiopathic scoliosis
Coupling
Fulcrumbending radiograph
Instrumentation
Rod precontouring
Thoracic kyphosis
Issue Date2010
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2010, v. 35 n. 11, p. 1158-1164 How to Cite?
AbstractSTUDY DESIGN.: Prospective clinical-radiographic study. OBJECTIVES.: To investigate the natural coupling behavior between frontal deformity correction and the simultaneous changes in thoracic kyphosis, and to examine how the postoperative thoracic sagittal realignment relates to this natural coupling behavior. SUMMARY OF BACKGROUND DATA.: Restoration of the sagittal alignment is one of the fundamental goals in scoliosis correction surgery. It is generally achieved by rod precontouring intraoperatively. However, clinical studies suggested that postoperative sagittal realignment seems to be more affected by the inherent properties of the spine rather than the instrumentation or the surgical maneuver. METHODS.: Ninety-eight idiopathic scoliosis patients with thoracic curves treated with one-stage posterior spinal fusion, using corrective segmental spinal instrumentation (hook-rod or pedicle screw-rod constructs) were investigated. Pre- and postoperative frontal and sagittal alignments were measured by standing anteroposterior and lateral radiographs. Preoperative frontal plane flexibility was assessed by the fulcrum bending radiograph in the standard manner, an additional radiograph was taken in the lateral plane, to assess how this frontal correction force affects sagittal plane alignment (lateral fulcrum bending radiograph). RESULTS.: When thoracic frontal deformity was corrected under fulcrum bending, coupled changes in the thoracic kyphosis demonstrated 3 different patterns: thoracic kyphosis increased in 25 patients with a mean kyphosis of 9° to 19°, decreased in 45 with a mean of 34° to 21° and remained unchanged (within 3°) in 28 with a mean of 19° to 18°. After surgery, the direction of correction of thoracic kyphosis significantly correlated with the coupling patterns demonstrated on fulcrum bending radiographs (r = 0.579, P < 0.001). However, the actual postoperative thoracic kyphosis angle cannot be predicted by the preoperative lateral fulcrum bending radiograph. There was no statistically significant difference (P = 0.263) between using pedicle screws and hooks in achieving the additional correction beyond what was demonstrated on the lateral fulcrum bending radiographs. CONCLUSION.: Changes in thoracic kyphosis on fulcrum bending due to natural coupling of deformities are directed towards "self-normalization." There is no difference in the sagittal plane deformity correction with the use of hook-rod system or pedicle screw-rod constructs. This can be used as a guideline for exact preoperative rod contouring to reduce the stress on the bone-implant interface and the rate of postoperative failures. The findings also suggest that it is not how big or strong the implants are, but rather the natural curve behavior will at least partially determine the final sagittal outcome. © 2010, Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/125163
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLuk, KDKen_HK
dc.contributor.authorVidyadhara, Sen_HK
dc.contributor.authorLu, DSen_HK
dc.contributor.authorWong, YWen_HK
dc.contributor.authorCheung, WYen_HK
dc.contributor.authorCheung, KMCen_HK
dc.date.accessioned2010-10-31T11:15:03Z-
dc.date.available2010-10-31T11:15:03Z-
dc.date.issued2010en_HK
dc.identifier.citationSpine, 2010, v. 35 n. 11, p. 1158-1164en_HK
dc.identifier.issn0362-2436en_HK
dc.identifier.urihttp://hdl.handle.net/10722/125163-
dc.description.abstractSTUDY DESIGN.: Prospective clinical-radiographic study. OBJECTIVES.: To investigate the natural coupling behavior between frontal deformity correction and the simultaneous changes in thoracic kyphosis, and to examine how the postoperative thoracic sagittal realignment relates to this natural coupling behavior. SUMMARY OF BACKGROUND DATA.: Restoration of the sagittal alignment is one of the fundamental goals in scoliosis correction surgery. It is generally achieved by rod precontouring intraoperatively. However, clinical studies suggested that postoperative sagittal realignment seems to be more affected by the inherent properties of the spine rather than the instrumentation or the surgical maneuver. METHODS.: Ninety-eight idiopathic scoliosis patients with thoracic curves treated with one-stage posterior spinal fusion, using corrective segmental spinal instrumentation (hook-rod or pedicle screw-rod constructs) were investigated. Pre- and postoperative frontal and sagittal alignments were measured by standing anteroposterior and lateral radiographs. Preoperative frontal plane flexibility was assessed by the fulcrum bending radiograph in the standard manner, an additional radiograph was taken in the lateral plane, to assess how this frontal correction force affects sagittal plane alignment (lateral fulcrum bending radiograph). RESULTS.: When thoracic frontal deformity was corrected under fulcrum bending, coupled changes in the thoracic kyphosis demonstrated 3 different patterns: thoracic kyphosis increased in 25 patients with a mean kyphosis of 9° to 19°, decreased in 45 with a mean of 34° to 21° and remained unchanged (within 3°) in 28 with a mean of 19° to 18°. After surgery, the direction of correction of thoracic kyphosis significantly correlated with the coupling patterns demonstrated on fulcrum bending radiographs (r = 0.579, P < 0.001). However, the actual postoperative thoracic kyphosis angle cannot be predicted by the preoperative lateral fulcrum bending radiograph. There was no statistically significant difference (P = 0.263) between using pedicle screws and hooks in achieving the additional correction beyond what was demonstrated on the lateral fulcrum bending radiographs. CONCLUSION.: Changes in thoracic kyphosis on fulcrum bending due to natural coupling of deformities are directed towards "self-normalization." There is no difference in the sagittal plane deformity correction with the use of hook-rod system or pedicle screw-rod constructs. This can be used as a guideline for exact preoperative rod contouring to reduce the stress on the bone-implant interface and the rate of postoperative failures. The findings also suggest that it is not how big or strong the implants are, but rather the natural curve behavior will at least partially determine the final sagittal outcome. © 2010, Lippincott Williams & Wilkins.en_HK
dc.languageengen_HK
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_HK
dc.relation.ispartofSpineen_HK
dc.rightsThis is a non-final version of an article published in final form in Spine, 2010, v. 35 n. 11, p. 1158-1164-
dc.subjectAdolescent idiopathic scoliosisen_HK
dc.subjectCouplingen_HK
dc.subjectFulcrumbending radiographen_HK
dc.subjectInstrumentationen_HK
dc.subjectRod precontouringen_HK
dc.subjectThoracic kyphosisen_HK
dc.titleCoupling between sagittal and frontal plane deformity correction in idiopathic thoracic scoliosis and its relationship with postoperative sagittal alignmenten_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0362-2436&volume=35&issue=11&spage=1158&epage=1164&date=2010&atitle=Coupling+between+sagittal+and+frontal+plane+deformity+correction+in+idiopathic+thoracic+scoliosis+and+its+relationship+with+post-operative+sagittal+alignmenten_HK
dc.identifier.emailLuk, KDK:hcm21000@hku.hken_HK
dc.identifier.emailCheung, KMC:cheungmc@hku.hken_HK
dc.identifier.authorityLuk, KDK=rp00333en_HK
dc.identifier.authorityCheung, KMC=rp00387en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/BRS.0b013e3181bb49f3en_HK
dc.identifier.pmid20118836-
dc.identifier.scopuseid_2-s2.0-77952399701en_HK
dc.identifier.hkuros180217en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77952399701&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume35en_HK
dc.identifier.issue11en_HK
dc.identifier.spage1158en_HK
dc.identifier.epage1164en_HK
dc.identifier.eissn1528-1159-
dc.identifier.isiWOS:000278074000011-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLuk, KDK=7201921573en_HK
dc.identifier.scopusauthoridVidyadhara, S=12795891700en_HK
dc.identifier.scopusauthoridLu, DS=7403079533en_HK
dc.identifier.scopusauthoridWong, YW=34882411200en_HK
dc.identifier.scopusauthoridCheung, WY=24504264600en_HK
dc.identifier.scopusauthoridCheung, KMC=7402406754en_HK

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