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Global Sagittal Alignment and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis
- Source :
- Spine Deformity, Spine Deformity, Springer Verlag, 2019, 7 (2), pp.236-244
- Publication Year :
- 2019
- Publisher :
- Springer Science and Business Media LLC, 2019.
-
Abstract
- Study design: Case-Control Study Objectives: To analyse global sagittal alignment including the cranial center of mass (CCOM) and proximal junctional kyphosis (PJK) in Adolescent Idiopathic Scoliosis (AIS) patients treated with posterior instrumentation. Summary of background data: PJK plays an important role in the global sagittal alignment in AIS patients. Maintaining the head above the pelvis allows for a minimization of energy expense in ambulation and upright posture. Numerous studies have been performed to understand PJK phenomena in AIS patients. However, to our knowledge, no study performed on AIS patients included the head in the analysis of global sagittal alignment and PJK. Methods: This study included 85 AIS patients and 51 asymptomatic adolescents. Low-dose bi-planar X-rays were acquired for each subject preoperatively and at two years follow up. Two global sagittal alignment parameters were calculated, i.e. the angle between the vertical and the line joining the center of the bi-coxofemoral axis (HA) and either the most superior point of the dentiform apophysis of C2 (OD) or the cranial center of mass (CCOM). Results: Among normal adolescents, the average OD-HA and CCOM-HA angles were -2.3°±2° and -1.5°±1.8°, respectively. Among AIS patients the average OD-HA and CCOM-HA angles were respectively -2.3°±1.9° and -1.3°±1.8° preoperatively and -2.8°±1.7° and -1.9°±1.7° at the last follow up. 13% of the patients developed PJK postoperatively. Case-by-case analysis showed that adjusting the thoracic kyphosis and the compensations required to maintain this constant could provide explanatory elements. Conclusions: OD-HA and CCOM-HA angles remain almost constant among normal group and patients, pre- and post-operatively, whether PJK or non-PJK. Five patients without PJK and only one patient with PJK produced abnormal values relative to the asymptomatic subjects. Therefore, PJK could be a compensation mechanism, which allows for CCOM-HA and, to a lesser extent, OD-HA to remain invariant. Level of Evidence: III BiomecAM chair on musculoskeletal modeling, with the support of Cotrel and ParisTech Foundations, Société Générale, Covea and Proteor.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
[SPI] Engineering Sciences [physics]
Radiography
Kyphosis
Idiopathic scoliosis
Scheuermann Disease
Sciences de l'ingénieur
PJK
Asymptomatic
[SPI]Engineering Sciences [physics]
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Pedicle Screws
Risk Factors
Humans
Medicine
Sagittal alignment
Orthopedic Procedures
Orthopedics and Sports Medicine
3D reconstruction
Child
Pelvis
Retrospective Studies
global balance
Orthodontics
030222 orthopedics
business.industry
AIS
medicine.disease
Normal group
Treatment Outcome
medicine.anatomical_structure
Scoliosis
Case-Control Studies
Orthopedic surgery
Quality of Life
Female
medicine.symptom
business
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 2212134X and 22121358
- Volume :
- 7
- Database :
- OpenAIRE
- Journal :
- Spine Deformity
- Accession number :
- edsair.doi.dedup.....4743d1a101d4ff60a0701124ecc1db9e