Saba Pasha1,2, Jean-Marc Mac-Thiong3,4,5. 1. Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA. pashas@email.chop.edu. 2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. pashas@email.chop.edu. 3. Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada. 4. Sainte-Justine University Hospital Research Center, Montreal, QC, Canada. 5. Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
Abstract
OBJECTIVE: The aim of this study was to identify the range of optimal versus suboptimal rates of spontaneous lumbar Cobb correction (SLCC%) and the factors predicting such outcomes in a cohort of Lenke 1 adolescent idiopathic scoliosis (AIS) after posterior spinal fusion surgery. METHODS: Seventy-one consecutive Lenke1 B and C AIS patients with a fusion level to L1 and higher with two-year follow-up were included. Thoracic kyphosis (T1-T4 and T4-T12 TK), lumbar lordosis (L1-S1 LL), thoracic and lumbar Cobb angles, thoracic and lumbar apical vertebral rotations and translations (AVR and AVT), pelvic incidence, sacral slope, and sagittal and frontal balances were measured at preoperative, early postoperative, and two-year follow-up. The SLCC% was calculated between preoperative and two-year follow-up. A clustering analysis determined the subgroups of patients with significantly higher and lower (optimal versus suboptimal) rate of SLCC% in the cohort at two-year follow-up. The cutoff values of the preoperative and early postoperative radiographic parameters that significantly predicted the optimal and suboptimal SLCC% were determined using a decision tree. RESULTS: The averages of the optimal versus suboptimal range of SLCC% in the cohort were 72% [55%, 105%] versus 39% [- 7%, 42%]. Preoperative and early postoperative spinal parameters predicted the optimal versus suboptimal SLCC% with an accuracy of 82%, 95%CI [0.73-0.94]. Preoperative AVTLumbar < 10 mm was a predictor of optimal SLCC%. In patients with a preoperative AVTLumbar > 10 mm, early postoperative T4-T12 TK < 24° (but not less than 17°) accompanied by - 5° < AVRThoracic < 5° were the main predictors of optimal SLCC% in our cohort. CONCLUSION: Quantitative clustering of the SLCC% into optimal and suboptimal groups allowed identifying the cutoff values of preoperative (AVTLumbar) and early postoperative (T4-T12 TK and AVRThoracic) spinal parameters that can predict the optimal range of SLCC% at two-year postoperative in our cohort of Lenke 1 AIS. LEVEL OF EVIDENCE: IV.
OBJECTIVE: The aim of this study was to identify the range of optimal versus suboptimal rates of spontaneous lumbar Cobb correction (SLCC%) and the factors predicting such outcomes in a cohort of Lenke 1 adolescent idiopathic scoliosis (AIS) after posterior spinal fusion surgery. METHODS: Seventy-one consecutive Lenke1 B and C AISpatients with a fusion level to L1 and higher with two-year follow-up were included. Thoracic kyphosis (T1-T4 and T4-T12 TK), lumbar lordosis (L1-S1 LL), thoracic and lumbar Cobb angles, thoracic and lumbar apical vertebral rotations and translations (AVR and AVT), pelvic incidence, sacral slope, and sagittal and frontal balances were measured at preoperative, early postoperative, and two-year follow-up. The SLCC% was calculated between preoperative and two-year follow-up. A clustering analysis determined the subgroups of patients with significantly higher and lower (optimal versus suboptimal) rate of SLCC% in the cohort at two-year follow-up. The cutoff values of the preoperative and early postoperative radiographic parameters that significantly predicted the optimal and suboptimal SLCC% were determined using a decision tree. RESULTS: The averages of the optimal versus suboptimal range of SLCC% in the cohort were 72% [55%, 105%] versus 39% [- 7%, 42%]. Preoperative and early postoperative spinal parameters predicted the optimal versus suboptimal SLCC% with an accuracy of 82%, 95%CI [0.73-0.94]. Preoperative AVTLumbar < 10 mm was a predictor of optimal SLCC%. In patients with a preoperative AVTLumbar > 10 mm, early postoperative T4-T12 TK < 24° (but not less than 17°) accompanied by - 5° < AVRThoracic < 5° were the main predictors of optimal SLCC% in our cohort. CONCLUSION: Quantitative clustering of the SLCC% into optimal and suboptimal groups allowed identifying the cutoff values of preoperative (AVTLumbar) and early postoperative (T4-T12 TK and AVRThoracic) spinal parameters that can predict the optimal range of SLCC% at two-year postoperative in our cohort of Lenke 1 AIS. LEVEL OF EVIDENCE: IV.
Authors: Guixing Qiu; Jianguo Zhang; Yipeng Wang; Hongguang Xu; Jia Zhang; Xisheng Weng; Jin Lin; Yu Zhao; Jianxiong Shen; Xinyu Yang; Keith D K Luk; Duosai Lu; William W Lu Journal: Spine (Phila Pa 1976) Date: 2005-06-15 Impact factor: 3.468
Authors: Jelle F Homans; Moyo C Kruyt; Tom P C Schlösser; Dino Colo; Kenneth Rogers; Suken A Shah; John M Flynn; René M Castelein; Saba Pasha Journal: J Pediatr Orthop Date: 2020-02 Impact factor: 2.324
Authors: Christopher J DeFrancesco; Saba Pasha; Daniel J Miller; Randal R Betz; David H Clements; Nicholas D Fletcher; Michael G Glotzbecker; Steven W Hwang; Michael P Kelly; Ronald A Lehman; Baron S Lonner; Peter O Newton; Benjamin D Roye; Paul D Sponseller; Vidyadhar V Upasani; Patrick J Cahill Journal: Spine Deform Date: 2018 Nov - Dec
Authors: Charles H Crawford; Lawrence G Lenke; Daniel J Sucato; B Stephens Richards; John B Emans; Michael G Vitale; Mark A Erickson; James O Sanders Journal: Spine (Phila Pa 1976) Date: 2013-07-15 Impact factor: 3.468
Authors: Saba Pasha; Victor Ho-Fung; Malcolm Eker; Sarah Nossov; Michael Francavilla Journal: BMC Musculoskelet Disord Date: 2020-12-08 Impact factor: 2.362