Convex–concave and anterior–posterior spinal length discrepancies in adolescent idiopathic scoliosis with major right thoracic curves versus matched controls

PURPOSE: The apical deformation in adolescent idiopathic scoliosis (AIS) is a combination of rotation, coronal deviation and passive anterior lengthening of the spine. In AIS surgery, posterior–concave lengthening or anterior–convex shortening can be part of the corrective maneuver, as determined by the individual surgeon’s technique. The magnitude of convex–concave and anterior–posterior length discrepancies, and how this needs to be modified to restore optimal spinal harmony, remains unknown. METHODS: CT-scans of 80 pre-operative AIS patients with right convex primary thoracic curves were sex- and age-matched to 80 healthy controls. The spinal length parameters of the main thoracic curves were compared to corresponding levels in controls. Vertebral body endplates and posterior elements were semi-automatically segmented to determine the length of the concave and convex side of the anterior column and along the posterior pedicle screw entry points while taking the 3D-orientation of each individual vertebra into account. RESULTS: The main thoracic curves showed anterior lengthening with a mean anterior–posterior length discrepancy of + 3 ± 6%, compared to a kyphosis of − 6 ± 3% in controls (p < 0.01). In AIS, the convex side was 20 ± 7% longer than concave (0 ± 1% in controls; p < 0.01). The anterior and posterior concavity were 7 and 22 mm shorter, respectively, while the anterior and posterior convexity were 21 and 8 mm longer compared to the controls. CONCLUSIONS: In thoracic AIS, the concave shortening is more excessive than the convex lengthening. To restore spinal harmony, the posterior concavity should be elongated while allowing for some shortening of the posterior convexity.