The Effect of the Thoracolumbar Junction on Spinopelvic Parameters in Lenke 1 Adolescent Idiopathic Scoliosis with Selective Fusion

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Abstract

Background

To compare the effect of the thoracolumbar junction angle (TLJ) on postoperative changes in both sagittal spinal and spinopelvic parameters in patients with Lenke type 1 adolescent idiopathic scoliosis (AIS) undergoing selective fusion surgery.

Methods

We retrospectively reviewed 42 patients with Lenke 1 AIS who were younger than 18 years of age and underwent posterior selective fusion in our center between 2010 and 2020. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), TLJ, cervical lordosis (CL), and sagittal vertical axis were evaluated using the Surgimap ( https://www.surgimap.com/) measurement system. Patients were divided into 2 groups: kyphotic and lordotic TLJ.

Results

Of the 42 AIS patients, 25 (60%) had kyphotic and 17 (40%) had lordotic TLJ alignment. Both groups had a median follow-up of 10 years. In the TLJ kyphotic group, PT was lower in the preoperative, immediate postoperative, and final follow-up examinations compared to the TLJ lordotic group, while TK was higher compared to the TLJ lordotic group ( p < 0.05). PI was significantly lower immediately postoperatively, while no statistically significant difference was observed preoperatively and at final follow-up. When all cases were evaluated, a statistically significant difference was found between preoperative, immediate postoperative, and final follow-up SS measurements ( p = 0.009). TK and LL were significantly decreased in both groups. While CL was significantly higher in the TLJ kyphotic group in the preoperative and immediate postoperative periods, no statistically significant difference was found at the final follow-up ( p > 0.05). Although the CL decreased in the kyphotic group, it remained within the lordotic alignment.

Conclusions

The fact that the PI and PT values of patients with thoracolumbar junction kyphotic were lower than those of the TLJ lordotic group should suggest that patients may have less compensatory abilities in sagittal alignment in advanced ages, and surgeons should consider this situation when applying spinal fusion. In addition, it was observed that the cervical spine in TLJ lordotic patients was prone to kyphosis to provide sagittal alignment.

Related collections

Most cited references 35

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Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis.

L G Lenke, R Betz, J. Harms … (2001)

The lack of a reliable, universally acceptable system for classification of adolescent idiopathic scoliosis has made comparisons between various types of operative treatment an impossible task. Furthermore, long-term outcomes cannot be determined because of the great variations in the description of study groups. We developed a new classification system with three components: curve type (1 through 6), a lumbar spine modifier (A, B, or C), and a sagittal thoracic modifier (-, N, or +). The six curve types have specific characteristics, on coronal and sagittal radiographs, that differentiate structural and nonstructural curves in the proximal thoracic, main thoracic, and thoracolumbar/lumbar regions. The lumbar spine modifier is based on the relationship of the center sacral vertical line to the apex of the lumbar curve, and the sagittal thoracic modifier is based on the sagittal curve measurement from the fifth to the twelfth thoracic level. A minus sign represents a curve of less than +10 degrees, N represents a curve of 10 degrees to 40 degrees, and a plus sign represents a curve of more than +40 degrees. Five surgeons, members of the Scoliosis Research Society who had developed the new system and who had previously tested the reliability of the King classification on radiographs of twenty-seven patients, measured the same radiographs (standing coronal and lateral as well as supine side-bending views) to test the reliability of the new classification. A randomly chosen independent group of seven surgeons, also members of the Scoliosis Research Society, tested the reliability and validity of the classification as well. The interobserver and intraobserver kappa values for the curve type were, respectively, 0.92 and 0.83 for the five developers of the system and 0.740 and 0.893 for the independent group of seven scoliosis surgeons. In the independent group, the mean interobserver and intraobserver kappa values were 0.800 and 0.840 for the lumbar modifier and 0.938 and 0.970 for the sagittal thoracic modifier. These kappa values were all in the good-to-excellent range (>0.75), except for the interobserver reliability of the independent group for the curve type (kappa = 0.74), which fell just below this level. This new two-dimensional classification of adolescent idiopathic scoliosis, as tested by two groups of surgeons, was shown to be much more reliable than the King system. Additional studies are necessary to determine the versatility, reliability, and accuracy of the classification for defining the vertebrae to be included in an arthrodesis.

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Diagnostic imaging of spinal deformities: reducing patients radiation dose with a new slot-scanning X-ray imager.

S P Deschenes, Josée Dubois, Gilles Beaudoin … (2010)

Clinical trial comparing image quality and entrance dose between Biospace EOS system, a new slot-scanning radiographic device, and a Fuji FCR 7501S computed radiography (CR) system for 50 patients followed for spinal deformities. Based on their physical properties, slot-scanners show the potential to produce image quality comparable to CR systems using less radiation. This article validates this assertion by comparing a new slot-scanner to a CR system through a wide-ranging evaluation of dose and image quality for scoliosis examinations. For each patient included in this study, lateral and posteroanterior images were acquired with both systems. For each system, entrance dose was measured for different anatomic locations. Dose and image quality being directly related, comparable images were obtained using the same radiograph tube voltage on both systems while tube currents were selected to match signal-to-noise ratios on a phantom. Different techniques were defined with respect to patient's thickness about the iliac crests. Given dose amplitudes expected for scoliosis examinations, optically stimulated luminescence dosimeters were chosen as optimal sensors. Two radiologists and 2 orthopedists evaluated the images in a randomized order using a questionnaire targeting anatomic landmarks. Visibility of the structures was rated on a 4 level scale. Image quality assessment was analyzed using a Wilcoxon signed-rank tests. Average skin dose was reduced from 6 to 9 times in the thoracoabdominal region when using the slot-scanner instead of CR. Moreover, image quality was significantly better with EOS for all structures in the frontal view (P < 0.006) and lateral view (P < 0.04), except for lumbar spinous processes, better seen on the CR (P < 0.003). We established that the EOS system offers overall enhanced image quality while reducing drastically the entrance dose for the patient.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Orthop Surg

Journal ID (iso-abbrev): Clin Orthop Surg

Journal ID (publisher-id): CIOS

Title: Clinics in Orthopedic Surgery

Publisher: The Korean Orthopaedic Association

ISSN (Print): 2005-291X

ISSN (Electronic): 2005-4408

Publication date (Print): June 2025

Publication date (Electronic): 15 May 2025

Volume: 17

Issue: 3

Pages: 427-437

Affiliations

Department of Orthopedics and Traumatology, Sakarya University Faculty of Medicine, Sakarya, Türkiye.

[* ]Department of Orthopedics and Traumatology, Bandırma Onyedi Eylül University Faculty of Medicine, Balıkesir, Türkiye.

Author notes

Correspondence to: Muhammed Fatih Serttas, MD. Department of Orthopedics and Traumatology, Sakarya University Faculty of Medicine, Şirinevler, Adnan Menderes Cd Sağlık Sk No:195, Sakarya 54100, Türkiye. Tel: +90-50-6983-8708, Fax: +90-264-275-9192, mfserttas@ 123456gmail.com

Author information

Muhammed Fatih Serttas https://orcid.org/0000-0001-8171-8855

Alauddin Kochai https://orcid.org/0000-0002-5775-102X

Fevzi Saglam https://orcid.org/0000-0001-9480-0022

Buğra Han Eryılmaz https://orcid.org/0009-0009-6764-7646

Uğur Özdemir https://orcid.org/0000-0003-2889-8118

Mustafa Erkan İnanmaz https://orcid.org/0000-0002-5385-6182

Article

DOI: 10.4055/cios24273

PMC ID: 12104034

PubMed ID: 40454137

SO-VID: adb33606-ce1a-4985-a864-e62cc49cf1af

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 June 2024

Date revision received : 13 November 2024

Date accepted : 05 January 2025