Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic vertebrae in Lenke 1 adolescent idiopathic scoliosis

Mizusaki, Danilo; Gotfryd, Alberto Ofenhejm

doi:10.1016/j.rboe.2015.03.013

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Original Articles • Rev. bras. ortop. 51 (1) • jan-feb 2016 • https://doi.org/10.1016/j.rboe.2015.03.013 copy

Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic vertebrae in Lenke 1 adolescent idiopathic scoliosis^{^☆} ☆ Work performed in the Spine Group, Department of Orthopedics and Traumatology, Santa Casa da Misericórdia de Santos, Santos, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To evaluate the clinical and radiographic response of the lumbar curve after fusion of the main thoracic vertebrae, in patients with adolescent idiopathic scoliosis of Lenke type 1.

METHODS:

Forty-two patients with Lenke 1 adolescent idiopathic scoliosis who underwent operations via the posterior route with pedicle screws were prospectively evaluated. Clinical measurements (size of the hump and translation of the trunk in the coronal plane, by means of a plumb line) and radiographic measurements (Cobb angle, distal level of arthrodesis, translation of the lumbar apical vertebral and Risser) were made. The evaluations were performed preoperatively, immediately postoperatively and two years after surgery.

RESULTS:

The mean Cobb angle of the main thoracic curve was found to have been corrected by 68.9% and the lumbar curve by 57.1%. Eighty percent of the patients presented improved coronal trunk balance two years after surgery. In four patients, worsening of the plumb line measurements was observed, but there was no need for surgical intervention. Less satisfactory results were observed in patients with lumbar modifier B.

CONCLUSIONS:

In Lenke 1 patients, fusion of the thoracic curve alone provided spontaneous correction of the lumbar curve and compensation of the trunk. Less satisfactory results were observed in curves with lumbar modifier B, and this may be related to overcorrection of the main thoracic curve.

Keywords:
Scoliosis; Bone screws; Treatment outcome

Variable	Description (n = 42)
Sex, n (%)
Male	4 (9.5)
Female	38 (90.5)

Age at time of diagnosis (years)
mean (SD)	11.95 (1.13)
median (min; max)	12 (11; 15)

Risser, n (%)
1	3 (7.1)
2	4 (9.5)
3	10 (23.8)
4	23 (54.8)
5	2 (4.8)

Lenke, n (%)
A	26 (61.9)
B	14 (33.3)
C	2 (4.8)

Arthrodesis level, n (%)
Finished at L1	32 (76.1)
Finished at T12	10 (23.9)

Proximal thoracic lateral inclination
mean (SD)	13.07 (7.56)
median (min; max)	13 (-6; 24)

Main thoracic lateral inclination
mean (SD)	29.07 (11.32)
median (min; max)	30 (6; 56)

Thoracolumbar/lumbar lateral inclination
mean (SD)	1.43 (11.09)
median (min; max)	2 (-29; 24)

Variable	Time	Mean	SD	Median	Minimum	Maximum	N	p
Hump (cm)	Before	2.23	0.92	2	0	4	42	<0.001^a
Hump (cm)	After	0.85	0.80	0.5	0	3	42	<0.001^a
Plumb	Before	1.25	1.23	1	0	5	42	<0.001^a
Plumb	After	0.25	0.59	0	0	3	42	<0.001^a
Cobb AP proximal thoracic curve	Before	24.69	7.34	24.5	12	45	42	<0.001
	Immediately after	12.57	6.84	10.5	2	32	42
	Two years after	12.64	6.89	10.5	2	30	42
Cobb AP main thoracic curve	Before	58.10	9.23	58	44	91	42	<0.001
	Immediately after	15.90	6.46	15.5	1	28	42
	Two years after	18.02	6.91	18	4	35	42
Cobb AP thoracolumbar/lumbar curve	Before	34.57	9.18	34	17	54	42	<0.001
	Immediately after	12.05	8.36	10	0	35	42
	Two years after	14.81	8.91	14.5	0	35	42
Translation of thoracic apical vertebra	Before	49.83	16.49	50	17	95	42	<0.001
	Immediately after	11.36	6.95	10	2	33	42
	Two years after	12.29	9.32	11	-4	45	41
Translation of lumbar apical vertebra	Before	12.63	10.39	13	-5	46	41	0.866
	Immediately after	12.59	10.87	11	-3	33	41
	Two years after	13.32	12.47	8	0	47	41
Instrumented distal vertebra inclination	Before	24.78	6.64	24	11	45	41	<0.001
	Immediately after	6.07	3.96	5	1	17	42
	Two years after	6.54	4.31	6	0	18	41

Variable	Comparison	Z value	p
Cobb AP proximal thoracic curve	Before vs. immed after	9.27	<0.001
	Before vs. two years after	8.55	<0.001
	Immed after vs. two years after	-0.71	0.476
Cobb AP main thoracic curve	Before vs. immed after	11.08	<0.001
	Before vs. two years after	8.36	<0.001
	Immed after vs. two years after	-2.72	0.006
COBB AP thoracolumbar/lumbar curve	Before vs. immed after	10.89	<0.001
	Before vs. two years after	8.10	<0.001
	Immed after vs. two years after	-2.79	0.005
Translation of thoracic apical vertebra	Before vs. immed after	10.43	<0.001
	Before vs. two years after	9.01	<0.001
	Immed after vs. two years after	-1.43	0.154
Instrumented distal vertebra inclination	Before vs. immed after	10.05	<0.001
	Before vs. two years after	9.40	<0.001
	Immed after vs. two years after	-0.65	0.517

Change in plumb	Lenke								p
	A		B		C		Total
	N	%	n	%	n	%	n	%
Worsened	1	3.8	3	21.4	0	0.0	4	9.5	0.097
No change	4	15.4	4	28.6	1	50.0	9	21.4
Improved	21	80.8	7	50.0	1	50.0	29	69.0
Total	26	100	14	100	2	100	42	100

Variable	Description (n = 42)
Change to hump
Worsened	2 (4.8)
Improved 0–25%	6 (14.3)
Improved 25–50%	8 (19)
Improved >50%	26 (61.9)

Change to plumb
Worsened	4 (9.5)
No change	9 (21.4)
Improved	29 (69)

Change to Cobb (thoracolumbar/lumbar)
Worsened	1 (2.4)
Improved 0–25%	1 (2.4)
Improved 25–50%	14 (33.3)
Improved >50%	26 (61.9)

Ration main Cobb/thoracolumbar/lumbar Cobb
> 1	24 (57.1)
Between 1 and 0.5	16 (38.1)
Between 0.5 and 0.25	1 (2.4)
<0.25	1 (2.4)

Variable	Lenke	Mean	SD	Median	Minimum	Maximum	N	p
Plumb before	A	1.52	1.35	1	0	5	26	0.093
	B	0.71	0.87	0.5	0	2.5	14
	C	1.50	0.71	1.5	1	2	2
Plumb after	A	0.19	0.43	0	0	2	26	0.604
	B	0.32	0.82	0	0	3	14
	C	0.50	0.71	0.5	0	1	2

Variable	Arthrodesis level						p
	Finished at L1		Finished at T12		Total
	N	%	n	%	n	%
Change to plumb							0.479
Worsened	2	6.2	2	20.0	4	9.6
No change	5	15.7	1	10.0	6	14.2
Improved	25	78.1	7	70.0	32	76.2

Change to thoracolumbar/lumbar Cobb							0.194
Worsened	0	0.0	1	10.0	1	2.3
Improved 0–25%	1	3.1	0	0.0	1	2.3
Improved 25–50%	9	28.1	4	40.0	13	31.1
Improved >50%	22	68.8	5	50.0	27	64.3
Total	32	100	10	100	42	100

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[1] * Corresponding author. E-mail: dan.mzk@gmail.com (D. Mizusaki).

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Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic vertebrae in Lenke 1 adolescent idiopathic scoliosis☆ ☆ Work performed in the Spine Group, Department of Orthopedics and Traumatology, Santa Casa da Misericórdia de Santos, Santos, SP, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic vertebrae in Lenke 1 adolescent idiopathic scoliosis^{^☆} ☆ Work performed in the Spine Group, Department of Orthopedics and Traumatology, Santa Casa da Misericórdia de Santos, Santos, SP, Brazil.