Document Detail

Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation.
MedLine Citation:
PMID:  22965380     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To analyze postoperative changes in the cervical sagittal alignment (CSA) of patients with AIS treated by posteromedial translation.
METHODS: 49 patients with thoracic AIS underwent posterior arthrodesis with hybrid constructs, combining lumbar pedicle screws and thoracic universal clamps. Posteromedial translation was the main correction technique used. 3D radiological parameters were measured from low-dose biplanar radiographs. CSA was assessed using the C2C6 angle, and the central hip vertical axis (CHVA) was used as a reference axis to evaluate patients' balance.
RESULTS: Preoperatively, 58 % of patients had thoracic hypokyphosis, and 79 % had a kyphotic CSA. Significant correlation was found (r = 0.45, P = 0.01) between thoracic hypokyphosis and cervical kyphosis. Increase in T4-T12 thoracic kyphosis (average 14.5° ± 10°) was associated with significant decrease in cervical kyphosis in the early postoperative period. The CSA further improved spontaneously during follow-up by 7.6° (P < 0.0001). Significant positive correlation (r = 0.32, P = 0.03) was found between thoracic and cervical improvements. At latest follow-up, 94 % of the patients were normokyphotic and 67 % had a CSA in the physiological range. Sagittal balance of the thoracolumbar spine was not significantly modified postoperatively. However, the procedure significantly changed the position of C2 in regard to the CHVA (C2-CHVA), which reflects headposition (P = 0.012). At last follow-up, the patients sagittal imbalance was not significantly different from the preoperative imbalance (P = 0.34).
CONCLUSIONS: Thoracic hypokyphosis and cervical hypolordosis, observed in AIS, can be improved postoperatively, when the posteromedial translation technique is used for correction. The cervical spine remains adaptable in most patients, but the proportion of patients with physiological cervical lordosis at final follow-up remained low (24.5 %).
Brice Ilharreborde; Christophe Vidal; Wafa Skalli; Keyvan Mazda
Publication Detail:
Type:  Journal Article     Date:  2012-09-11
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  22     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-07-22     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  330-7     Citation Subset:  IM    
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MeSH Terms
Bone Screws
Cervical Vertebrae / radiography,  surgery*
Kyphosis / etiology*,  radiography
Lordosis / etiology*,  radiography
Postoperative Period
Scoliosis / radiography,  surgery*
Spinal Fusion / adverse effects*,  instrumentation
Thoracic Vertebrae / radiography,  surgery*
Treatment Outcome

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