Pre- and Postoperative Spinopelvic Sagittal Balance in Adolescent Patients With Lenke Type 5 Idiopathic Scoliosis

Study Design. A retrospective study. Objective. To investigate the preoperative spinopelvic sagittal alignment in Lenke 5 patients with adolescent idiopathic scoliosis (AIS), and analyze how it alters after posterior correction. Summary of Background Data. The structural thoracolumbar or lumbar curve may change the local sagittal alignment thereby altering the sagittal balance in Lenke 5 patients with AIS. However, few studies have evaluated the spinopelvic sagittal alignment before and after the surgery in these patients. Methods. Forty-eight Lenke 5 patients with AIS who underwent posterior correction and fusion were included in this study. Preoperative and postoperative radiographs were reviewed measuring both the coronal and sagittal parameters. Three pelvic sagittal states (anteverted, normal, or retroverted) were evaluated according to the magnitude relationship of individual pelvic tilt with pelvic incidence (PI). Both the coronal and sagittal parameters between different pelvic sagittal states were compared. The alterations of these parameters by surgery would also be analyzed. Results. The mean follow-up was 1.8 years. Preoperatively, the mean PI was 44.3° with a pelvic tilt of 4.1°. There was 48% patients showing the anteverted pelvis, whereas the remaining 52% showing normal. The patients with anteverted pelvis showed a smaller PI and more distal lower end vertebra than normal pelvis ones. Logistic regression analysis revealed PI (odds ratio [OR] = 0.62, P = 0.024) and lower end vertebra (OR = 2.1, P = 0.037) were significantly associated with the risk of developing anteverted pelvis. The pelvic tilt was significantly increased and 61% of patients with preoperative anteverted pelvis had recovered. Logistic regression analysis revealed PI (OR = 0.7, P = 0.034) and lower instrumented vertebra (OR = 6.5, P = 0.002) were significantly associated with the risk of postoperative uncovered of anteverted pelvis. Conclusion. Anteverted pelvis appears in almost half of Lenke 5 patients with AIS, especially in who have smaller PI or distal lower end vertebra. The abnormal pelvic sagittal state will be generally corrected by posterior correction surgery except for patients with a PI less than 39° or a lower instrumented vertebra that extends to L5. Level of Evidence: 4

[1]  Zixuan Liu,et al.  Sagittal Balance in Adolescent Idiopathic Scoliosis , 2015, Medicine.

[2]  C. Aubin,et al.  Three-Dimensional Spinopelvic Relative Alignment in Adolescent Idiopathic Scoliosis , 2014, Spine.

[3]  Yueming Song,et al.  The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases , 2014, European Spine Journal.

[4]  P. Roussouly,et al.  Compensatory mechanisms contributing to keep the sagittal balance of the spine , 2013, European Spine Journal.

[5]  V. Rampal,et al.  Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis , 2013, European Spine Journal.

[6]  Hai-sheng Li,et al.  Lowest Instrumented Vertebra Selection for Lenke 5C Scoliosis: A Minimum 2-Year Radiographical Follow-up , 2013, Spine.

[7]  H. Labelle,et al.  Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults , 2013, European Spine Journal.

[8]  Jing-feng Li,et al.  Analysis of Radiographic Parameters Relevant to the Lowest Instrumented Vertebrae and Postoperative Coronal Balance in Lenke 5C Patients , 2011, Spine.

[9]  R. Betz,et al.  19 The Surgical Treatment of Lumbar and Thoracolumbar Curve Patterns (Lenke Type 5): Anterior versus Posterior Approach , 2011 .

[10]  Jean-Paul Steib,et al.  Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis , 2011, European Spine Journal.

[11]  Eric Berthonnaud,et al.  Sagittal Parameters of Global Spinal Balance: Normative Values From a Prospective Cohort of Seven Hundred Nine Caucasian Asymptomatic Adults , 2010, Spine.

[12]  Hae-Ryong Song,et al.  Correlation of Pelvic Orientation With Adult Scoliosis , 2010, Journal of spinal disorders & techniques.

[13]  Ashish Patel,et al.  Sagittal Plane Considerations and the Pelvis in the Adult Patient , 2009, Spine.

[14]  P. Roussouly,et al.  SPINOPELVIC ALIGNMENT OF PATIENTS WITH DEGENERATIVE SPONDYLOLISTHESIS , 2007, Neurosurgery.

[15]  A. Crawford,et al.  Analysis of Sagittal Alignment in Thoracic and Thoracolumbar Curves in Adolescent Idiopathic Scoliosis: How Do These Two Curve Types Differ? , 2007, Spine.

[16]  J. Mac-Thiong,et al.  Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis , 2007, European Spine Journal.

[17]  P. Roussouly,et al.  Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases , 2007, European Spine Journal.

[18]  R. Betz,et al.  Sagittal spinopelvic balance in normal children and adolescents , 2007, European Spine Journal.

[19]  H. Labelle,et al.  Analysis of the Sagittal Balance of the Spine and Pelvis Using Shape and Orientation Parameters , 2005, Journal of spinal disorders & techniques.

[20]  Hubert Labelle,et al.  Sagittal Alignment of the Spine and Pelvis During Growth , 2004, Spine.

[21]  T. Matsuno,et al.  A Longitudinal Study of Congruent Sagittal Spinal Alignment in an Adult Cohort , 2004, Spine.

[22]  L. Lenke,et al.  Late Complications of Adult Idiopathic Scoliosis Primary Fusions to L4 and Above: The Effect of Age and Distal Fusion Level , 2004, Spine.

[23]  Hubert Labelle,et al.  Sagittal Plane Analysis of the Spine and Pelvis in Adolescent Idiopathic Scoliosis According to the Coronal Curve Type , 2003, Spine.

[24]  Jeffrey C. Wang,et al.  L5–S1 Segment Survivorship and Clinical Outcome Analysis After L4–L5 Isolated Fusion , 2003, Spine.

[25]  Tamás Illés,et al.  Sagittal plane correction in idiopathic scoliosis. , 2002, Spine.

[26]  E. Berthonnaud,et al.  Sagittal morphology and equilibrium of pelvis and spine , 2002, European Spine Journal.

[27]  Jürgen Harms,et al.  Adolescent Idiopathic Scoliosis , 2001 .

[28]  J. Hecquet,et al.  Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves , 1998, European Spine Journal.