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In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?

STUDY DESIGN: Retrospective single-center study. OBJECTIVE: Investigate the effect of posterior instrumentation on the relationship between lordosis and kyphosis. METHODS: Surgically treated patients with a minimum of 6 months of follow-up were analyzed. Asymptomatic volunteers served to show the no...

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Autores principales: Ang, Bryan, Lafage, Renaud, Elysée, Jonathan Charles, Pannu, Tejbir S., Bannwarth, Mathieu, Carlson, Brandon B., Schwab, Frank J., Kim, Han Jo, Lafage, Virginie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119914/
https://www.ncbi.nlm.nih.gov/pubmed/32875889
http://dx.doi.org/10.1177/2192568220914882
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author Ang, Bryan
Lafage, Renaud
Elysée, Jonathan Charles
Pannu, Tejbir S.
Bannwarth, Mathieu
Carlson, Brandon B.
Schwab, Frank J.
Kim, Han Jo
Lafage, Virginie
author_facet Ang, Bryan
Lafage, Renaud
Elysée, Jonathan Charles
Pannu, Tejbir S.
Bannwarth, Mathieu
Carlson, Brandon B.
Schwab, Frank J.
Kim, Han Jo
Lafage, Virginie
author_sort Ang, Bryan
collection PubMed
description STUDY DESIGN: Retrospective single-center study. OBJECTIVE: Investigate the effect of posterior instrumentation on the relationship between lordosis and kyphosis. METHODS: Surgically treated patients with a minimum of 6 months of follow-up were analyzed. Asymptomatic volunteers served to show the normal anatomical relationship between thoracic and lumbar curves. Patients were stratified based on postoperative instrumentation: “Thoracic Fusion” = complete fusion of thoracic spine; “Lumbar Fusion” = complete fusion of lumbar spine; and “Complete Fusion” = fusion from sacrum to at least T5. Bivariate correlations and regression analysis were used to evaluate the relationship between change in thoracic kyphosis (ΔTK) and change in spinopelvic mismatch (ΔPI-LL; pelvic incidence-lumbar lordosis) before and after fusion. Analyses were repeated in “Lumbar Fusion” patients with flexible preoperative thoracic spines. RESULTS: For asymptomatic volunteers, the natural anatomical relationship between TK and LL was found to be TK = 41% of LL (r = 0.425, P < .001). A total of 153 of 167 adult spinal deformity patients were included (62 years old, 26.7 kg/m(2), 78% female). Mean follow-up was 11.5 ± 6.8 months. “Thoracic Fusion” group showed no alteration in the natural relationship between TK and LL (ΔTK = 39% ΔPI-LL), whereas “Lumbar Fusion” group had a reduction in reciprocal change (ΔTK = 34% ΔPI-LL) although a subanalysis of patients in the “Lumbar Fusion” group with flexible thoracic spines showed a marked compensation in reciprocal change with (ΔTK = 58% ΔPI-LL). CONCLUSION: The relationship between ΔTK and ΔPI-LL is dependent on level instrumented. “Thoracic Fusion” drives change in LL while this relationship is affected by TK’s natural stiffness in “Lumbar Fusion” patients.
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spelling pubmed-81199142021-05-21 In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which? Ang, Bryan Lafage, Renaud Elysée, Jonathan Charles Pannu, Tejbir S. Bannwarth, Mathieu Carlson, Brandon B. Schwab, Frank J. Kim, Han Jo Lafage, Virginie Global Spine J Original Articles STUDY DESIGN: Retrospective single-center study. OBJECTIVE: Investigate the effect of posterior instrumentation on the relationship between lordosis and kyphosis. METHODS: Surgically treated patients with a minimum of 6 months of follow-up were analyzed. Asymptomatic volunteers served to show the normal anatomical relationship between thoracic and lumbar curves. Patients were stratified based on postoperative instrumentation: “Thoracic Fusion” = complete fusion of thoracic spine; “Lumbar Fusion” = complete fusion of lumbar spine; and “Complete Fusion” = fusion from sacrum to at least T5. Bivariate correlations and regression analysis were used to evaluate the relationship between change in thoracic kyphosis (ΔTK) and change in spinopelvic mismatch (ΔPI-LL; pelvic incidence-lumbar lordosis) before and after fusion. Analyses were repeated in “Lumbar Fusion” patients with flexible preoperative thoracic spines. RESULTS: For asymptomatic volunteers, the natural anatomical relationship between TK and LL was found to be TK = 41% of LL (r = 0.425, P < .001). A total of 153 of 167 adult spinal deformity patients were included (62 years old, 26.7 kg/m(2), 78% female). Mean follow-up was 11.5 ± 6.8 months. “Thoracic Fusion” group showed no alteration in the natural relationship between TK and LL (ΔTK = 39% ΔPI-LL), whereas “Lumbar Fusion” group had a reduction in reciprocal change (ΔTK = 34% ΔPI-LL) although a subanalysis of patients in the “Lumbar Fusion” group with flexible thoracic spines showed a marked compensation in reciprocal change with (ΔTK = 58% ΔPI-LL). CONCLUSION: The relationship between ΔTK and ΔPI-LL is dependent on level instrumented. “Thoracic Fusion” drives change in LL while this relationship is affected by TK’s natural stiffness in “Lumbar Fusion” patients. SAGE Publications 2020-04-01 2021-05 /pmc/articles/PMC8119914/ /pubmed/32875889 http://dx.doi.org/10.1177/2192568220914882 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Ang, Bryan
Lafage, Renaud
Elysée, Jonathan Charles
Pannu, Tejbir S.
Bannwarth, Mathieu
Carlson, Brandon B.
Schwab, Frank J.
Kim, Han Jo
Lafage, Virginie
In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?
title In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?
title_full In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?
title_fullStr In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?
title_full_unstemmed In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?
title_short In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?
title_sort in the relationship between change in kyphosis and change in lordosis: which drives which?
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119914/
https://www.ncbi.nlm.nih.gov/pubmed/32875889
http://dx.doi.org/10.1177/2192568220914882
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