Peter O Newton1, Kuan Wen Wu2, Tracey P Bastrom3, Carrie E Bartley3, Vidyadhar V Upasani4, Burt Yaszay4. 1. Department of Orthopedics, Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA 92123, USA; Department of Orthopedics, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA. Electronic address: pnewton@rchsd.org. 2. Department of Orthopaedic Surgery, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei City, Taiwan 100. 3. Department of Orthopedics, Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA 92123, USA. 4. Department of Orthopedics, Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA 92123, USA; Department of Orthopedics, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
Abstract
STUDY DESIGN: Review of a prospective adolescent idiopathic scoliosis (AIS) multicenter registry. OBJECTIVE: To evaluate predictors of surgical thoracic kyphosis restoration in AIS patients with lordotic preoperative thoracic sagittal profiles. SUMMARY OF BACKGROUND DATA: Prior work on kyphosis-producing techniques has yielded mixed findings and has focused on the sagittal plane in 2D. METHODS: A validated formula to predict 3D T5-T12 sagittal alignment using standard 2D measures was applied in a cohort of 1614 Lenke 1-4 patients treated with posterior instrumentation using 5.5-mm-diameter rods. Patients with 3D kyphosis 1 standard deviation (12.2°) below the mean (5.3°) were identified as the study cohort. Predictors of 3D T5-T12 kyphosis at two years were evaluated using univariate analysis followed by Classification and Regression Tree (CART). RESULTS: There were 134 patients identified. All had preoperative 3D T5-T12 kyphosis of <-7°. The average 3D kyphosis was -13° ± 5° preoperatively and 20° ± 7° at two years (p < .001). The thoracic coronal curve improved from 62° ± 12° to 21° ± 8° at two years (p < .001). Of 15 variables analyzed, multivariate CART analysis identified only surgeon as a predictor of 2-year kyphosis. Two surgeon groups were identified by CART which included those who restored more kyphosis versus those who restored less. Subsequent analysis demonstrated significant differences between groups in the rate of Ponte osteotomies used (p < .023), stainless steel versus cobalt chromium rods (p < .001), and segmental screw fixation (p < .001). CONCLUSION: Kyphosis restoration in patients with preoperative lordosis in the thoracic sagittal plane is possible. In this analysis, there was not one single technique identified as being solely responsible for the ability to restore kyphosis. The most predictive factor identified was the surgeon performing the correction, which is likely a reflection of focus on deformity correction in three planes, as well as a combination of methods used to restore kyphosis. LEVEL OF EVIDENCE: Level III, therapeutic.
STUDY DESIGN: Review of a prospective adolescent idiopathic scoliosis (AIS) multicenter registry. OBJECTIVE: To evaluate predictors of surgical thoracic kyphosis restoration in AISpatients with lordotic preoperative thoracic sagittal profiles. SUMMARY OF BACKGROUND DATA: Prior work on kyphosis-producing techniques has yielded mixed findings and has focused on the sagittal plane in 2D. METHODS: A validated formula to predict 3D T5-T12 sagittal alignment using standard 2D measures was applied in a cohort of 1614 Lenke 1-4 patients treated with posterior instrumentation using 5.5-mm-diameter rods. Patients with 3D kyphosis 1 standard deviation (12.2°) below the mean (5.3°) were identified as the study cohort. Predictors of 3D T5-T12 kyphosis at two years were evaluated using univariate analysis followed by Classification and Regression Tree (CART). RESULTS: There were 134 patients identified. All had preoperative 3D T5-T12 kyphosis of <-7°. The average 3D kyphosis was -13° ± 5° preoperatively and 20° ± 7° at two years (p < .001). The thoracic coronal curve improved from 62° ± 12° to 21° ± 8° at two years (p < .001). Of 15 variables analyzed, multivariate CART analysis identified only surgeon as a predictor of 2-year kyphosis. Two surgeon groups were identified by CART which included those who restored more kyphosis versus those who restored less. Subsequent analysis demonstrated significant differences between groups in the rate of Ponte osteotomies used (p < .023), stainless steel versus cobalt chromium rods (p < .001), and segmental screw fixation (p < .001). CONCLUSION:Kyphosis restoration in patients with preoperative lordosis in the thoracic sagittal plane is possible. In this analysis, there was not one single technique identified as being solely responsible for the ability to restore kyphosis. The most predictive factor identified was the surgeon performing the correction, which is likely a reflection of focus on deformity correction in three planes, as well as a combination of methods used to restore kyphosis. LEVEL OF EVIDENCE: Level III, therapeutic.