Abstract
Purpose
The purpose of the present study was to validate a new spinal sagittal classification.
Methods
We retrospectively included 105 consecutive AIS patients who underwent posterior spinal fusion. Preoperative long-standing EOS radiographs were available on all patients. Patients were classified according to the four suggested sagittal patterns: type 1, 2a, 2b or 3. Several predetermined sagittal parameters were compared between the groups.
Results
The mean preoperative Cobb angle was 64° ± 12°, and 73% of the patients were female. Of 105 patients, 51 were type 1, 14 were type 2a, one was type 2b and 39 were type 3. The distribution of the four sagittal patterns was significantly different compared with the original publication (p < 0.05). However, the two study populations were comparable in terms of Lenke and Roussouly types (p = 0.49 and 0.47, respectively). In our study population, the sagittal groups differed significantly in terms of thoracic kyphosis, length of thoracic and lumbar curves, lumbar lordosis, thoracic slope, C7 slope, pelvic incidence and sacral slope (p < 0.05).
Conclusion
The distribution of the four sagittal patterns varies between AIS cohorts. Type 2b was rare, which limits the clinical applicability. Contrary to the original publication, we found that the spinopelvic parameters lumbar lordosis, pelvic incidence and sacral slope were significantly different between the Abelin-Genevois types. Hence, the corrective surgical strategy may need to incorporate these spinopelvic parameters to achieve a balanced spine requiring a minimum of energy expenditure.
Graphic abstract
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Change history
28 January 2020
Unfortunately, the names of the members of the Texas Children’s Hospital Spine Study Group have not been mentioned in the published article.
References
Glassman SD, Berven S, Bridwell K et al (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30:682–688
Faundez A, Hoffmeyer P, Aunoble S et al (2014) Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop 39:87–95. https://doi.org/10.1007/s00264-014-2516-6
Bhagat S, Vozar V, Lutchman L et al (2013) Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience. Eur Spine J 22:42–46. https://doi.org/10.1007/s00586-012-2627-y
de Jonge T, Dubousset JF, Illés T (2002) Sagittal plane correction in idiopathic scoliosis. Spine (Phila Pa 1976) 27:754–760
Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis. J Bone Jt Surg Am 83:1169–1181. https://doi.org/10.2106/00004623-200108000-00006
Abelin-Genevois K, Sassi D, Verdun S, Roussouly P (2018) Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications. Eur Spine J. https://doi.org/10.1007/s00586-018-5613-1
Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30:346–353
Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836. https://doi.org/10.1007/s00586-010-1476-9
O’Brien MFO, Kuklo TR (2004) Radiographic measurement manual Editors in Chief
Ohrt-Nissen S, Hallager DW, Karbo T et al (2017) Radiographic and functional outcome in adolescent idiopathic scoliosis operated with hook/hybrid versus all-pedicle screw instrumentation—a retrospective study in 149 patients. Spine Deform 5:401–408. https://doi.org/10.1016/j.jspd.2017.05.002
Post M, Verdun S, Roussouly P, Abelin-Genevois K (2018) New sagittal classification of AIS: validation by 3D characterization. Eur Spine J. https://doi.org/10.1007/s00586-018-5819-2
Lee CS, Lee D-H, Hwang CJ et al (2017) Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery? J Neurosurg Pediatr 21:292–301. https://doi.org/10.3171/2017.8.peds17357
Roussouly P, Labelle H, Rouissi J, Bodin A (2013) Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J. https://doi.org/10.1007/s00586-012-2571-x
Pepke W, Almansour H, Lafage R et al (2019) Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients. BMC Surg 19:1–12. https://doi.org/10.1186/s12893-019-0471-2
Grob D, Frauenfelder H, Mannion AF (2007) The association between cervical spine curvature and neck pain. Eur Spine J 16:669–678. https://doi.org/10.1007/s00586-006-0254-1
Jeon WK, Kang SS, Youn MS et al (2016) Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J 25:3114–3119. https://doi.org/10.1007/s00586-016-4488-2
Ilharreborde B, Vidal C, Skalli W, Mazda K (2013) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation. Eur Spine J 22:330–337. https://doi.org/10.1007/s00586-012-2493-7
Canavese F, Turcot K, De Rosa V et al (2011) Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J 20:1141–1148. https://doi.org/10.1007/s00586-011-1837-z
La Maida GA, Zottarelli L, Mineo GV, Misaggi B (2013) Sagittal balance in adolescent idiopathic scoliosis: radiographic study of spino-pelvic compensation after surgery. Eur Spine J 22(Suppl 6):S859–S867. https://doi.org/10.1007/s00586-013-3018-8
Mac-Thiong JM, Labelle H, Berthonnaud E et al (2007) Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 16:227–234. https://doi.org/10.1007/s00586-005-0013-8
Pasha S, Aubin C-E, Sangole AP et al (2014) Three-dimensional spinopelvic relative alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39:564–570. https://doi.org/10.1097/BRS.0000000000000193
Betz RR, Labelle H, Mac-Thiong J-M et al (2004) Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976) 29:1642–1647. https://doi.org/10.1097/01.brs.0000132312.78469.7b
Lonner BS, Auerbach JD, Sponseller P et al (2010) Variations in pelvic and other sagittal spinal parameters as a function of race in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:374–377. https://doi.org/10.1097/BRS.0b013e3181bb4f96
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B. Dahl and M. Gehrchen have received institutional grants from K2M and Medtronic. J. Heydemann is a comitee member of POSNA, AACPDM and SRS and shareholder in Merck, Sanofi Avanti and Orthopediatrics, unrelated to this work. L. Deveza is a shareholder in Lento Medical Inc. and has received research funding from OREF (Orthopedic Research an Education Fund), unrelated to this work. C. Dragsted, S. Ohrt-Nissen, M. Jain, D. Liu and S. Fruergaard have no conflicts of interest.
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Fruergaard, S., Jain, M.J., Deveza, L. et al. Evaluation of a new sagittal classification system in adolescent idiopathic scoliosis. Eur Spine J 29, 744–753 (2020). https://doi.org/10.1007/s00586-019-06241-5
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DOI: https://doi.org/10.1007/s00586-019-06241-5