Journal article
More severe thoracic idiopathic scoliosis is associated with a greater three-dimensional loss of thoracic kyphosis
Spine deformity, Vol.8(6), pp.1205-1211
12/01/2020
DOI: 10.1007/s43390-020-00149-7
PMID: 32488764
Abstract
Study designRetrospective.ObjectivesUtilize three-dimensional (3D) measurements to assess the relationship between thoracic scoliosis severity and thoracic kyphosis in a large, multicenter cohort, and determine impact of 3D measurements on adolescent idiopathic scoliosis (AIS) curve classification.Summary of background dataResearch has demonstrated differences in two-dimensional (2D) and 3D assessment of the sagittal plane deformity in AIS. A prior smaller, single-institution study demonstrated an association between scoliosis severity and loss of 3D thoracic kyphosis.MethodsData included retrospective compilation of prospectively enrolled bracing candidates and prospectively enrolled surgical candidates with thoracic AIS. Analysis included two groups based on thoracic curve magnitude: moderate (20-45 degrees) and severe (>45 degrees). Imaging was performed using 2D radiographs. 3D thoracic kyphosis was calculated using a 2D to 3D conversion formula. Kyphosis was categorized according to the Lenke classification sagittal plane modifier.ResultsAnalysis included 3032 patients. 2D kyphosis was significantly less in the moderate group (2112 vs 2314, p=0.028). However, estimated 3D kyphosis was significantly greater in the moderate group (13 +/- 10 vs 5 +/- 12, p<0.001). In the moderate group, the rate of normokyphosis was 78% with 2D measures and 61% with 3D measures of T5-T12 kyphosis. In the severe group, this rate changed from 72 to 32% with use of 2D and 3D measures, respectively. In the moderate group, 16% of patients were classified as hypokyphotic using 2D measures while this rate increased 38% with 3D measures (p<0.001). In the severe group, this rate changed from 18 to 68% using 2D and 3D measures, respectively (p<0.001).Conclusions Increased coronal curve severity was associated with decreased thoracic kyphosis. Hypokyphosis was more pronounced in 3D. 2D radiographs increasingly underestimate kyphosis with increasing coronal severity. Assessment of sagittal alignment from 2D radiographs can be improved with a 2D-3D conversion formula. Findings indicate potential for classification system improvement with use of 3D sagittal plane measurements.Level of evidenceIV.
Details
- Title: Subtitle
- More severe thoracic idiopathic scoliosis is associated with a greater three-dimensional loss of thoracic kyphosis
- Creators
- Thomas Barrett Sullivan - University of California, San DiegoTracey P. Bastrom - Rady Children's Hospital-San DiegoCarrie E. Bartley - Rady Children's Hospital-San DiegoLori A. Dolan - University of IowaStuart L. Weinstein - University of IowaPeter O. Newton - University of California, San Diego
- Resource Type
- Journal article
- Publication Details
- Spine deformity, Vol.8(6), pp.1205-1211
- Publisher
- Springer Nature
- DOI
- 10.1007/s43390-020-00149-7
- PMID
- 32488764
- ISSN
- 2212-134X
- eISSN
- 2212-1358
- Number of pages
- 7
- Grant note
- Medtronic EOS imaging R21AR049587; R01AR052113 / National Institute of Arthritis and Musculoskeletal and Skin Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) University of Rochester K2M Zimmer Biomet Children's Mercy Hospital and Clinics Shriners Hospitals for Children DePuy Synthes Spine NuVasive Children's Miracle Network Canadian Institutes of Health Research; Canadian Institutes of Health Research (CIHR)
- Language
- English
- Date published
- 12/01/2020
- Academic Unit
- Stead Family Department of Pediatrics; Orthopedics and Rehabilitation
- Record Identifier
- 9984304726102771
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