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Hou C, Chen K, Chen Y, Zhou T, Yang M, Li M. Assessment of sagittal spinopelvic alignment in asymptomatic Chinese juveniles and adolescents: a large cohort study and comparative meta-analysis. J Orthop Surg Res 2021; 16:656. [PMID: 34727958 PMCID: PMC8561890 DOI: 10.1186/s13018-021-02773-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/04/2021] [Indexed: 01/10/2023] Open
Abstract
STUDY DESIGN Retrospective study and comparative meta-analysis. OBJECTIVE To document the sagittal spinopelvic alignment in a large cohort study in asymptomatic Chinese juveniles and adolescents, and to explore whether these parameters were different from various regions using meta-analysis. METHODS Medical records of 656 asymptomatic Chinese juveniles and adolescents were reviewed, whose mean age was 13.14 ± 3.41 years old, including 254 male and 402 female volunteers. Demographic and lateral radiological parameters were evaluated. Furthermore, a systematic online search was performed to identify eligible studies. Weight mean difference (WMD) with 95% confidence interval (CI) were used to evaluate whether these sagittal parameters were different from various regions. RESULTS The mean value of sagittal spinopelvic alignment in this study was calculated and analyzed respectively. Significant differences of PI (34.20 ± 4.00 vs. 43.18 ± 7.12, P < 0.001) and PT (3.99 ± 6.04 vs. 8.42 ± 7.08, P < 0.001) were found between juveniles and adolescents. A total of 17 studies were recruited for meta-analysis. For juvenile populations, TK, PI and SS of Caucasians were significantly larger than those of our study (all P < 0.001). As for adolescent populations, PI (P = 0.017), TK (P = 0.017) and SS (P < 0.001) of Caucasians was found to be greater when compared with that of our study. All in all, TK, PI and SS in Chinese pre-adult populations were significantly smaller than those populations in Caucasian regions (all P < 0.001). CONCLUSION Our study was the first large-scale study that reported the mean values of sagittal parameters in asymptomatic Chinese juveniles and adolescents. There were significant differences in TK, PI and SS between our study and other previous reported populations, which reminded us for using specific mean values in different populations when restoring a relatively normal sagittal spinopelvic balance in spinal deformity.
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Affiliation(s)
- Canglong Hou
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, 200433, China
| | - Kai Chen
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, 200433, China
| | - Yu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Tianjunke Zhou
- Basic Medicine College, Navy Medical University, Shanghai, 200433, China
| | - Mingyuan Yang
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, 200433, China.
| | - Ming Li
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, 200433, China.
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Clément JL, Pesenti S, Ilharreborde B, Morin C, Charles YP, Parent HF, Violas P, Szadkowski M, Boissière L, Solla F. Proximal junctional kyphosis is a rebalancing spinal phenomenon due to insufficient postoperative thoracic kyphosis after adolescent idiopathic scoliosis surgery. 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 2021; 30:1988-1997. [PMID: 34021786 DOI: 10.1007/s00586-021-06875-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Many authors tried to explain proximal junctional kyphosis (PJK) after adolescent idiopathic scoliosis (AIS) surgery by looking for risk factors. Latest publications focus on sagittal alignment. Each healthy adolescent has a specific thoracic kyphosis (TK) depending on their pelvic parameters and lumbar lordosis (LL). The objective of this work is to determine if the difference between TK at follow-up (TKFU) and the patient-specific TK (PSTK) plays a role in PJK occurrence after AIS surgery. The secondary objective was to find other risk factors. METHODS We analyzed retrospectively 570 thoracic AIS who underwent a posterior thoracic fusion from nine centers. The series was separated in two groups: with and without PJK. PSTK was calculated with the formula PSTK = 2(PT + LL-PI). TK Gap was the difference between TKFU and PSTK. Logistic regression was utilized to test the impact of TK Gap and other known risk factors on PJK occurrence. RESULTS Univariate analysis showed 15 factors significantly different between the groups. In a multivariate analysis, three factors had a strong significant influence on PJK: TKFU, TK Gain and TK Gap. Four additional factors affected the rate of PJK: Posterior translation on two rods, preoperative TK, preoperative LL and number of instrumented vertebrae. CONCLUSION PJK is related to the insufficient TK at follow-up, compared to the specific TK that every patient should have according to their pelvic parameters. PJK incidence is significantly reduced by a strong gain in TK and a thoracic selective fusion which leaves the proximal lumbar vertebrae free. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Jean-Luc Clément
- Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux Pédiatriques de Nice Chu Lenval, 57 Avenue de la Californie, 06200, Nice, France.
| | - Sebastien Pesenti
- Pediatric Orthopedics, Hôpital Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005, Marseille, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopedics, CHU Robert Debré, AP-HP, University of Paris, 48 Bd Sérurier, 75019, Paris, France
| | - Christian Morin
- Department of Pediatric Orthopedics, Institut Calot, rue du Dr Calot, 62600, Berck sur mer, France
| | - Yann-Philippe Charles
- Department of Spine Surgery, Fédération de Médecine Translationnelle (FMTS), Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
| | | | - Philippe Violas
- Department of Pediatric Surgery, Hôpital Sud, CHU de Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Marc Szadkowski
- Santy Orthopedic Center, 24 avenue Paul Santy, 69008, Lyon, France
| | - Louis Boissière
- Department of Orthopaedic Surgery, Spine Unit, CHU Bordeaux Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Federico Solla
- Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux Pédiatriques de Nice Chu Lenval, 57 Avenue de la Californie, 06200, Nice, France
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Chen L, Liu C, Liao S, Yu C, Liang T, Qin Z, Huang S, Sun X, Yi M, Lu Z, Wang Z, Xu G, Zhang Z, Chen J, Jiang J, Zhan X. A Retrospective Study of Factors Associated with Restoration of Thoracic Kyphosis in 43 Patients with Adolescent Idiopathic Scoliosis with Lenke Type 1 Curvature. Med Sci Monit 2021; 27:e929149. [PMID: 33608494 PMCID: PMC7903848 DOI: 10.12659/msm.929149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This retrospective study aimed to identify the factors associated with successful surgical correction of thoracic kyphosis (TK) in 43 patients with adolescent idiopathic scoliosis (AIS) with Lenke type 1 curvature, in which the major curve with the largest Cobb angle was mainly in the thoracic region. MATERIAL AND METHODS We collected data from patients with Lenke 1 AIS. The following parameters were measured: Cobb angle, side-bending Cobb angle, cervical lordosis (CL), TK, lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), the sagittal vertical axis (SVA), the center of a C7 plumb line to the center sacral vertical line (C7-CSVL), correction rate, Ponte osteotomy, flexibility, and screw density. Univariate analysis and multivariate logistic regression analyses were performed. RESULTS Among the 43 cases analyzed, the mean postoperative Cobb angle at the last follow-up, C7-CSVL, SVA, CL, TK, LL, PI, SS, and PT were respectively 21.33±9.47°, 10.41±8.45 mm, 19.68±14.33 mm, 16.19±7.45°, 23.12±7.45°, 50.33±11.37°, 49.70±9.83°, 39.42±8.11°, and 10.16±6.63°. Univariate analysis suggested that preoperative TK, preoperative LL, and Ponte osteotomy were statistically significant (P<0.05), and multivariate analysis suggested that preoperative LL and Ponte osteotomy were statistically significant (P<0.05). CONCLUSIONS The results of this study demonstrated that preoperative TK, preoperative LL, and Ponte osteotomy were related factors for maintaining normal TK. Multivariate analysis suggested that preoperative LL and the use of Ponte osteotomy with full-thickness segmental resection of the spinal posterior column resulted in the successful surgical correction of TK in patients with AIS with Lenke type 1 curvature.
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Affiliation(s)
- Liyi Chen
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Chong Liu
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Shian Liao
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Chaojie Yu
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Tuo Liang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Zhaojie Qin
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Shengsheng Huang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xuhua Sun
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Ming Yi
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Zhaojun Lu
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Zequn Wang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Guoyong Xu
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Zide Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Jiarui Chen
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Jie Jiang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xinli Zhan
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
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Clément JL, Solla F, Amorese V, Oborocianu I, Rosello O, Rampal V. Lumbopelvic parameters can be used to predict thoracic kyphosis in adolescents. 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 2020; 29:2281-2286. [PMID: 32185541 DOI: 10.1007/s00586-020-06373-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/02/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Distal thoracic kyphosis (DTK) equivalent to proximal lumbar lordosis (PLL) is the sum of pelvic tilt (PT) and the difference (Δ) between lumbar lordosis (LL) and pelvic incidence (PI): PLL = DTK = PT + Δ. With the assumption that proximal thoracic kyphosis (PTK) is similar to DTK, we propose the equation TK = 2(PT + LL - PI) to express the relationship between thoracic kyphosis (TK) and pelvic parameters. The objective of this work is to verify this relationship in a normal population. METHODS Full spine radiographs of 100 adolescents and young adults (13 to 20 years old), free from vertebral pathology, were analyzed. Measurements included pelvic parameters, LL, PLL, DLL, TK, PTK, DTK and C7 global tilt. The measured global TK was compared with the theoretical TK calculated according to the formula TK = 2(PT + LL - PI). RESULTS The difference between measured TK and calculated TK was + 2.3° and correlated with the C7 global tilt (r = 0.86). There was a significant linear regression between TK and PT + ∆ (p < 0.0001). Given radiographs' inter-rater reliability of 5° for angled measurements, the p value (0.047) between measured TK and calculated TK is statistically significant to support the hypothesis. CONCLUSION This work validates the formula TK = 2(PT + LL - PI) which allows the calculation of global TK as a function of PT, LL and PI. This calculated TK can be used as a target for sagittal correction of adolescents with spine deformities. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Jean-Luc Clément
- Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux pédiatriques de Nice CHU LENVAL, 57 Avenue de la Californie, Nice, France.
| | - Federico Solla
- Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux pédiatriques de Nice CHU LENVAL, 57 Avenue de la Californie, Nice, France
| | - Veronica Amorese
- Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux pédiatriques de Nice CHU LENVAL, 57 Avenue de la Californie, Nice, France
| | - Ioana Oborocianu
- Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux pédiatriques de Nice CHU LENVAL, 57 Avenue de la Californie, Nice, France
| | - Olivier Rosello
- Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux pédiatriques de Nice CHU LENVAL, 57 Avenue de la Californie, Nice, France
| | - Virginie Rampal
- Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux pédiatriques de Nice CHU LENVAL, 57 Avenue de la Californie, Nice, France
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