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Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study)

BACKGROUND: Postoperative coronal imbalance is a significant problem after selective thoracic fusion for primary thoracic and compensatory lumbar curves in adolescent idiopathic scoliosis (AIS). However, longitudinal studies on postoperative behavior of coronal balance are lacking. This multicenter...

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Autores principales: Ishikawa, Masayuki, Cao, Kai, Pang, Long, Fujita, Nobuyuki, Yagi, Mitsuru, Hosogane, Naobumi, Tsuji, Takashi, Machida, Masafumi, Ishihara, Shinichi, Nishiyama, Makoto, Fukui, Yasuyuki, Nakamura, Masaya, Matsumoto, Morio, Watanabe, Kota
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427598/
https://www.ncbi.nlm.nih.gov/pubmed/28516166
http://dx.doi.org/10.1186/s13013-017-0123-1
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author Ishikawa, Masayuki
Cao, Kai
Pang, Long
Fujita, Nobuyuki
Yagi, Mitsuru
Hosogane, Naobumi
Tsuji, Takashi
Machida, Masafumi
Ishihara, Shinichi
Nishiyama, Makoto
Fukui, Yasuyuki
Nakamura, Masaya
Matsumoto, Morio
Watanabe, Kota
author_facet Ishikawa, Masayuki
Cao, Kai
Pang, Long
Fujita, Nobuyuki
Yagi, Mitsuru
Hosogane, Naobumi
Tsuji, Takashi
Machida, Masafumi
Ishihara, Shinichi
Nishiyama, Makoto
Fukui, Yasuyuki
Nakamura, Masaya
Matsumoto, Morio
Watanabe, Kota
author_sort Ishikawa, Masayuki
collection PubMed
description BACKGROUND: Postoperative coronal imbalance is a significant problem after selective thoracic fusion for primary thoracic and compensatory lumbar curves in adolescent idiopathic scoliosis (AIS). However, longitudinal studies on postoperative behavior of coronal balance are lacking. This multicenter retrospective study was conducted to analyze factors related to onset and remodeling of postoperative coronal imbalance after posterior thoracic fusion for Lenke 1C and 2C AIS. METHODS: Twenty-one Lenke 1C or 2C AIS patients, who underwent posterior thoracic fusion ending at L3 or above, were included with a minimum 2-year follow-up. The mean patients’ age was 15.1 years at the time of surgery. Radiographic measurements were performed on Cobb angles of the main thoracic (MT) and thoracolumbar/lumbar (TLL) curves and coronal balance. Factors related to the onset of immediately postoperative coronal decompensation (IPCD) and postoperative coronal balance remodeling (PCBR), defined as an improvement of coronal balance during postoperative follow-up, were investigated using comparative and correlation analyses. RESULTS: Mean Cobb angles for the MT and TLL curves were 57.3° and 42.3° preoperatively and were corrected to 22.8° and 22.5° at final follow-up, respectively. Mean preoperative coronal balance of −3.8 mm got worse to −21.2 mm postoperatively, and regained to −12.0 mm at final follow-up. Coronal decompensation was observed in two patients preoperatively, in ten patients immediately postoperatively, and in three patients at final follow-up. The preoperative coronal balance and lowest instrumented vertebra (LIV) selection relative to stable vertebra (SV) were significantly different between patients with IPCD and those without. PCBR had significantly negative correlation with immediately postoperative coronal balance. CONCLUSIONS: IPCD after posterior thoracic fusion for Lenke 1C and 2C AIS was frequent and associated with preoperative coronal balance and LIV selection. However, most patients with IPCD regained coronal balance through PCBR, which was significantly associated with immediately postoperative coronal balance. A fixation more distal to SV shifted the coronal balance further to the left postoperatively.
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spelling pubmed-54275982017-05-17 Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study) Ishikawa, Masayuki Cao, Kai Pang, Long Fujita, Nobuyuki Yagi, Mitsuru Hosogane, Naobumi Tsuji, Takashi Machida, Masafumi Ishihara, Shinichi Nishiyama, Makoto Fukui, Yasuyuki Nakamura, Masaya Matsumoto, Morio Watanabe, Kota Scoliosis Spinal Disord Research BACKGROUND: Postoperative coronal imbalance is a significant problem after selective thoracic fusion for primary thoracic and compensatory lumbar curves in adolescent idiopathic scoliosis (AIS). However, longitudinal studies on postoperative behavior of coronal balance are lacking. This multicenter retrospective study was conducted to analyze factors related to onset and remodeling of postoperative coronal imbalance after posterior thoracic fusion for Lenke 1C and 2C AIS. METHODS: Twenty-one Lenke 1C or 2C AIS patients, who underwent posterior thoracic fusion ending at L3 or above, were included with a minimum 2-year follow-up. The mean patients’ age was 15.1 years at the time of surgery. Radiographic measurements were performed on Cobb angles of the main thoracic (MT) and thoracolumbar/lumbar (TLL) curves and coronal balance. Factors related to the onset of immediately postoperative coronal decompensation (IPCD) and postoperative coronal balance remodeling (PCBR), defined as an improvement of coronal balance during postoperative follow-up, were investigated using comparative and correlation analyses. RESULTS: Mean Cobb angles for the MT and TLL curves were 57.3° and 42.3° preoperatively and were corrected to 22.8° and 22.5° at final follow-up, respectively. Mean preoperative coronal balance of −3.8 mm got worse to −21.2 mm postoperatively, and regained to −12.0 mm at final follow-up. Coronal decompensation was observed in two patients preoperatively, in ten patients immediately postoperatively, and in three patients at final follow-up. The preoperative coronal balance and lowest instrumented vertebra (LIV) selection relative to stable vertebra (SV) were significantly different between patients with IPCD and those without. PCBR had significantly negative correlation with immediately postoperative coronal balance. CONCLUSIONS: IPCD after posterior thoracic fusion for Lenke 1C and 2C AIS was frequent and associated with preoperative coronal balance and LIV selection. However, most patients with IPCD regained coronal balance through PCBR, which was significantly associated with immediately postoperative coronal balance. A fixation more distal to SV shifted the coronal balance further to the left postoperatively. BioMed Central 2017-05-12 /pmc/articles/PMC5427598/ /pubmed/28516166 http://dx.doi.org/10.1186/s13013-017-0123-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Ishikawa, Masayuki
Cao, Kai
Pang, Long
Fujita, Nobuyuki
Yagi, Mitsuru
Hosogane, Naobumi
Tsuji, Takashi
Machida, Masafumi
Ishihara, Shinichi
Nishiyama, Makoto
Fukui, Yasuyuki
Nakamura, Masaya
Matsumoto, Morio
Watanabe, Kota
Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study)
title Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study)
title_full Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study)
title_fullStr Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study)
title_full_unstemmed Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study)
title_short Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study)
title_sort onset and remodeling of coronal imbalance after selective posterior thoracic fusion for lenke 1c and 2c adolescent idiopathic scoliosis (a pilot study)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427598/
https://www.ncbi.nlm.nih.gov/pubmed/28516166
http://dx.doi.org/10.1186/s13013-017-0123-1
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