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Sakashita K, Kotani T, Sakuma T, Iijima Y, Okuyama K, Akazawa T, Minami S, Ohtori S, Koda M, Yamazaki M. Risk factors for vertebral bridging in residual adolescent idiopathic scoliosis with thoracolumbar/lumbar curves. J Orthop Sci 2023; 28:1246-1251. [PMID: 36462997 DOI: 10.1016/j.jos.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/17/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Although vertebral bridging in residual adolescent idiopathic scoliosis (AIS) can make corrective surgery more complicated, no study has investigated the risk factors. The purpose of this research was to determine risk factors for vertebral bridging in individuals with residual AIS with thoracolumbar/lumbar (TL/L) curves. METHODS Forty-two pre-operative patients with residual AIS and TL/L curves (3 males, 39 females: age 41.9 ± 18.0 years) were divided into bridging (n = 17) and non-bridging (n = 25) groups. All patients were 20 years or older with a diagnosis of AIS in adolescence. The bridging group consisted of patients with third or more degree bridging by the Nathan classification. RESULTS There were significant differences in age, absolute value of apical vertebral translation (AVT), C7 translation, and L3,4 tilt between groups. There was no significant difference in TL/L Cobb angle. Multivariate analyses and ROC curves demonstrated that older age was a significant risk factor for vertebral bridging (odds ratio [OR]: 1.08; 95% confidence interval: 1.02-1.14; P = 0.004), with a cutoff value of 38.0 years old. CONCLUSIONS This study indicates that patients >38 years old are at risk for vertebral bridging in residual AIS. Because of the higher risk of vertebral bridging and other degenerative changes, residual AIS patients about 40 years of age are at a critical point for treatment strategy. Because appropriate surgical time should not be missed, regular follow-up is required even after 30 years of age, especially if the patient with residual AIS has a large TL/L curve indicated for surgery.
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Affiliation(s)
- Kotaro Sakashita
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan; Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan.
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Kohei Okuyama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University, School of Medicine, Kawasaki, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
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Farshad M, Götschi T, Bauer DE, Böni T, Laux CJ, Kabelitz M. Long-term outcome of patients with adolescent idiopathic scoliosis seeking nonoperative treatment after a mean follow-up of 42 years. Spine Deform 2022; 10:1331-1338. [PMID: 35819723 PMCID: PMC9579110 DOI: 10.1007/s43390-022-00541-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) affects up to 3% of otherwise healthy adolescents. The extreme long-term outcomes of nonoperative treatment are underreported. This study aimed to investigate the long-term outcome of nonoperative-treated AIS patients. Comparison between a bracing and an observation approach were performed. METHODS In a retrospective cohort study, 20 nonoperatively treated AIS patients were observed concerning patient-related outcome measures (PROM) (visual analog scale (VAS), Short Form Health Survey 36 item (SF 36), Scoliosis Research Society (SRS 24), Oswestry Low Back Pain Disability Index (ODI), Psychological General Well-Being Index (PGWBI)), radiological curve progression and health-related quality of life (HRQoL). Baseline characteristics and radiological imaging were collected. At follow-up, anteroposterior and lateral X-rays as well as questionnaires were analyzed. RESULTS Twenty patients (16 females, mean age: 14.6 ± 3.2 years) with a follow-up time of 42 ± 9 years were included. Nine patients (initial Cobb 35° ± 19°) were treated with bracing for a mean time of 26 ± 9 months, while the other 11 patients (initial Cobb 29° ± 11°) were observed. The primary curve progressed from 32° ± 15° to 52° ± 25° in average with no significant difference between the cohorts (p = 0.371). At final follow-up, a mean ODI score of 7 ± 7.9 points with no difference depending on the treatment (p = 0.668) was seen. No significant differences were observed for PROMs. Curve magnitude correlated neither at diagnosis (p = 0.617) nor at follow-up (p = 0.535) with the ODI score at final follow-up. CONCLUSION After a mean of 42 years, patients with nonoperative treatment of moderate AIS demonstrated a good clinical outcome despite progression of the deformity. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, 8008 Zurich, Switzerland
| | - David E. Bauer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Thomas Böni
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Christoph J. Laux
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Method Kabelitz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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Kotani T, Sakuma T, Iijima Y, Aoki Y, Sakashita K, Okuyama K, Sunami T, Sato K, Asada T, Akazawa T, Inage K, Shiga Y, Hozumi T, Minami S, Ohtori S. Risk Factors for Lateral Translation in Residual Adolescent Idiopathic Scoliosis with a Thoracolumbar/Lumbar Curve. Spine Surg Relat Res 2022; 6:247-251. [PMID: 35800620 PMCID: PMC9200425 DOI: 10.22603/ssrr.2021-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Although lateral vertebral translation is associated with inducing curve progression and pain, no study has analyzed risk factors for lateral slip in patients with residual adolescent idiopathic scoliosis (AIS). This study aimed to investigate risk factors for lateral slip in patients with residual AIS. Methods We included 42 preoperative patients with residual AIS with a thoracolumbar/lumbar (TL/L) curve (3 male, 39 female; age 41.9±18.2 years, TL/L Cobb angle 55.5±10.0°). All patients were >20 years and had been diagnosed with AIS during their adolescence. Lateral slip was defined as more than a 6-mm slip on coronal CT images. Results Patients were divided into slip (n=22) and nonslip (n=20) groups. Significant differences were observed in age, TL/L Cobb angle, TL/L curve flexibility, lumbar lordosis, thoracolumbar kyphosis, apical vertebral rotation, apical vertebral translation, and L3 and L4 tilt between the groups. Multivariate analyses and receiver operating characteristic curves found that only older age was a significant risk factor for lateral slip (odds ratio: 1.214; 95% confidence interval: 1.047-1.407; P=0.010), with a cutoff value of 37 years old. Conclusions Older age, especially >37 years, is a risk factor for lateral slip in patients with residual AIS. These findings suggest that surgery for residual AIS should be considered before patients are in their mid-30s to avoid lateral translation.
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Affiliation(s)
- Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Yasuchika Aoki
- Department of Orthopedic Surgery, Eastern Chiba Medical Center
| | - Kotaro Sakashita
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Kohei Okuyama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | | | - Kosuke Sato
- Department of Orthopedic Surgery, University of Tsukuba
| | | | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University, School of Medicine
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Chiba University, Graduate School of Medicine
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Chiba University, Graduate School of Medicine
| | - Takashi Hozumi
- Department of Orthopedic Surgery, Chiba University, Graduate School of Medicine
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University, Graduate School of Medicine
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Akazawa T, Kotani T, Sakuma T, Nakayama K, Iijima Y, Torii Y, Iinuma M, Kuroya S, Asano K, Ueno J, Yoshida A, Murakami K, Minami S, Orita S, Inage K, Shiga Y, Nakamura J, Inoue G, Miyagi M, Saito W, Eguchi Y, Fujimoto K, Takahashi H, Ohtori S, Niki H. Pulmonary Function Improves in Patients with Adolescent Idiopathic Scoliosis who Undergo Posterior Spinal Fusion Regardless of Thoracoplasty: A Mid-Term Follow-Up. Spine Surg Relat Res 2020; 5:22-27. [PMID: 33575491 PMCID: PMC7870321 DOI: 10.22603/ssrr.2020-0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/29/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction The purpose of the present study was to determine, in a mid-term follow-up 5 years or more after surgery, the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and expiratory flow in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) with or without thoracoplasty. Methods The subjects were 134 patients with AIS who underwent PSF between 2004 and 2013. Forty-five patients agreed to participate in the study. We divided the patients into two groups as follows: 24 patients who underwent PSF with thoracoplasty from 2004 to 2010 in the TP group and 21 patients who underwent PSF without thoracoplasty from 2011 to 2013 in the non-TP group. We evaluated whole spine X-ray imaging and pulmonary function tests (PFTs) in these patients. PFTs measured FVC, FEV1, peak expiratory flow (PEF), maximum expiratory flow at 50% FVC (V50), maximum expiratory flow at 25% FVC (V25), and the ratio of V50 to V25 (V50/V25). Results The main thoracic curves were 53.6 ± 10.1° before surgery, 19.8 ± 7.6° 1 week after surgery, 22.3 ± 8.3° 2 years after surgery, and 23.3 ± 7.6° at the most recent observation. Compared with preoperative values, FVC, FEV1, and % FEV1 were improved significantly at the most recent observation. No significant difference was observed between % FVC before surgery and at the most recent observation. Compared with preoperative values, PEF, V50, and V25 were improved significantly at the most recent observation. V50/V25 did not change significantly. The changes in PFT values in the TP group and the non-TP group were compared. No significant differences were observed in FVC, % FVC, FEV1, % FEV1, PEF, V50, or V25. Conclusions Regardless of whether thoracoplasty was performed or not, FVC, FEV1, and expiratory flow were improved 5 years or later after PSF.
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Affiliation(s)
- Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Keita Nakayama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yoshiaki Torii
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masahiro Iinuma
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shingo Kuroya
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Kota Asano
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Jun Ueno
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Atsuhiro Yoshida
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenichi Murakami
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Orthopaedic Surgery, Konodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
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Ristolainen L, Kettunen JA, Danielson H, Heliövaara M, Schlenzka D. Magnetic resonance imaging findings of the lumbar spine, back symptoms and physical function among male adult patients with Scheuermann's disease. J Orthop 2020; 21:69-74. [PMID: 32139999 DOI: 10.1016/j.jor.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022] Open
Abstract
Background There are only a few studies on untreated Scheuermann's disease and magnetic resonance imaging (MRI) findings in the lumbar spine. The primary aim of this study was to clarify lumbar MRI findings in patients with Scheuermann's disease and to compare with subjects without diagnosed spine disease. Methods Twenty-two male adult Scheuermann's patients (mean age 64.7 years (Standard Deviation [SD] 6.4) and 26 males (mean age 59.7 years [SD 7.4]) from a national health survey were included in this study. From MR images, the dimensions of the vertebral bodies, intervertebral discs and the dural sac were measured. Spondylolisthesis, Modic changes (MC), high intensity zone values (HIZ), and Schmorl's nodes were registered from both groups as well as self-reported data concerning general health, quality of life, and back pain symptoms. Results Significantly more patients with Scheuermann's disease had at least one MC compared to the controls at the level L1/L2 (Odds Ratio [OR] 21.11, 95% Confidence Interval [95% CI] 2.31-192.96), at the level L3/L4 (OR 13.62, 95% CI 1.41-131.26), and at the level L5/S1 (OR 6.11, 95% CI 1.50-24.83). Patients had significantly more Schmorl's nodes compared to the controls (64% vs. 8%, p < 0.001). The area of the dura sac (L3/L4) was larger (mean 201 mm2 vs. 152 mm2, p = 0.017) in the patients compared to controls. At level L1/L2 patients had higher disc than controls (mean 7.9 mm vs. 6.8 mm, p = 0.038). After adjusting for age patients had more commonly constant back pain (OR 9.4, 95% CI 1.56-56.97), and difficulties in walking up one floor without resting (OR 9.8, 95% CI 1.01-95.34) than controls. Conclusions Schmorl's nodes and Modic changes on lumbar MRI, back pain and physical function restrictions seem to be more prevalent among patients with Scheuermann's disease than in the general population.
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Affiliation(s)
- Leena Ristolainen
- Orton Orthopaedic Hospital, Helsinki, Finland, Tenholantie 10, PL 29, 00281, Helsinki, Finland
| | - Jyrki A Kettunen
- Arcada, University of Applied Sciences, Jan-Magnus Janssonin aukio 1, 00560, Helsinki, Finland
| | - Heidi Danielson
- Orton Orthopaedic Hospital, Helsinki, Finland, Tenholantie 10, PL 29, 00281, Helsinki, Finland
| | - Markku Heliövaara
- National Institute for Health and Welfare, Helsinki, Finland, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland
| | - Dietrich Schlenzka
- Research Institute Orton, Helsinki, Finland, Tenholantie 10, PL 29, 00281, Helsinki, Finland
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Akazawa T, Umehara T, Iinuma M, Asano K, Kuroya S, Torii Y, Murakami K, Kotani T, Sakuma T, Minami S, Orita S, Inage K, Shiga Y, Nakamura J, Inoue G, Miyagi M, Saito W, Eguchi Y, Fujimoto K, Takahashi H, Ohtori S, Niki H. Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years. Spine Surg Relat Res 2019; 4:50-56. [PMID: 32039297 PMCID: PMC7002063 DOI: 10.22603/ssrr.2019-0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/12/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction Despite preserving lumbar disc mobility, spinal sagittal, and/or coronal alignment might ultimately impede surgical success. The purpose of this study was to elucidate the effects of spinal alignment on lumbar disc degeneration after 5 or more years in adolescent idiopathic scoliosis (AIS) patients who underwent spinal fusion. Methods Subjects were 49 AIS patients who underwent posterior spinal fusion without lumbar curve fusion. The inclusion criteria were the following: 1) Lenke type 1A, 1B, 2A or 2B, 2) age 10 to 19 years at the time of operation, and 3) minimum 5-year follow-up. The exclusion criteria were the following: 1) diagnosed as other than AIS, 2) history of lumbar disc herniation and spondylolysis, 3) subsequent surgery, and 4) history of surgery before AIS surgery. Nineteen patients agreed to participate in this research. X-rays, lumbar MRI, and questionnaires were evaluated. Disc degeneration in non-fused segments was defined as Pfirrmann grade 3 or higher. Patients with disc degenerations at the final observation (DD[+] group) were compared to those without disc degenerations (DD[−] group). Results There were no significant differences in the preoperative or postoperative 1-week X-ray parameters between both groups. The lumbar curve was significantly larger in the DD[+] group compared with the DD[−] group at the final observation (DD[+]: 16.8 degrees, DD[−]: 10.4 degrees, p = 0.035). The sagittal vertical axis (SVA) was significantly larger in the DD[+] group compared with the DD[−] group at the final observation (DD[+]: −4.4 mm, DD[−]: −34.3 mm, p = 0.006). SRS-22 function, self-image, and satisfaction scores were lower in the DD [+] group compared with the DD[−] group at the final observation. Conclusions The patients with DD had significantly larger lumbar curve and SVA with lower SRS-22 function, self-image, and satisfaction scores at the final observation. Even though the non-fused segments were preserved, spinal alignments of non-fused lumbar curve affect the DDs.
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Affiliation(s)
- Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.,Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tasuku Umehara
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masahiro Iinuma
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kota Asano
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shingo Kuroya
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshiaki Torii
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kenichi Murakami
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Orthopaedic Surgery, National Hospital Organization, Shimoshizu Hospital, Yotsukaido, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Orthopaedic Surgery, Konodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
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7
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Tournemine S, Angelliaume A, Simon AL, Ilharreborde B. Are postoperative standing radiographs relevant before hospital discharge in adolescent idiopathic scoliosis? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1363-1370. [PMID: 30972568 DOI: 10.1007/s00586-019-05971-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/19/2019] [Accepted: 04/05/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Postoperative standing radiographs are usually performed before hospital discharge after AIS fusion. However, patients are often still painful and have not recovered yet their physiological balance. The aim of this study was therefore to evaluate the relevance of such early radiographs and more specifically investigate whether postoperative alignment could be analyzed. METHODS All consecutive AIS patients operated between January 2015 and December 2015 were included. All patients underwent biplanar stereoradiographs before hospital discharge, at 4 months postoperative and at last follow-up. Fifteen parameters (eight coronal and seven sagittal), reflecting correction and spinal alignment were measured and compared. The incidence of implant misplacement, requiring or not surgical revision, was recorded. RESULTS In total, 100 patients were included. A significant difference was found for 12 out of the 15 (80%) parameters between the first erect radiograph and the 4-month follow-up visit, including the CVA and the SVA, which are commonly used to assess postoperative alignment. Clavicle, UIV and LIV tilts also decreased significantly at 4 months postoperative. In opposition, no significant change occurred for the same parameters between the 4-month visit and latest follow-up. In nine patients, a pedicle screw was considered misplaced on the first radiograph, but all patients remained asymptomatic and no revision was performed. CONCLUSION There is no need for additional immediate postoperative radiographs in AIS, if an intraoperative radiograph has already been taken. This finding could help reducing radiation exposure in immature patients and should be further studied in other etiologies. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- S Tournemine
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Boulevard Serurier, 75019, Paris, France
| | - A Angelliaume
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Boulevard Serurier, 75019, Paris, France
| | - A L Simon
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Boulevard Serurier, 75019, Paris, France
| | - B Ilharreborde
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Boulevard Serurier, 75019, Paris, France.
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