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The changes of the interspace angle after anterior correction and instrumentation in adolescent idiopathic scoliosis patients.

Wang Y, Qiu G, Yu B, Zhang J, Li J, Weng X, Shen J, Fei Q, Li Q - J Orthop Surg Res (2007)

Bottom Line: There was significant correlation between the loss of the interspace angle and the loss of coronal Cobb angle of the main curve during follow-up(r = 0.483, P = 0.007).The interspace angle could be improved after anterior correction and instrumentation surgery, but it became larger during follow-up.The loss of the interspace angle was correlated with the loss of coronal Cobb angle of the main curve during follow-up.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. ypwang@medmail.com.cn

ABSTRACT

Background: In idiopathic scoliosis patients, after anterior spinal fusion and instrumentation, the discs (interspace angle) between the lowest instrumented vertebra (LIV) and the next caudal vertebra became more wedged. We reviewed these patients and analyzed the changes of the angle.

Methods: By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients underwent anterior spinal fusion and instrumentation, Cobb angle of the curve, correction rate, coronal balance, LIV rotation, interspace angle were measured and analyzed.

Results: There were total 30 patients included. The mean coronal Cobb angle of the main curve (thoracolumbar/lumbar curve) before and after surgery were 48.9 degrees and 11.7 degrees , respectively, with an average correction rate of 76.1%. The average rotation of LIV before surgery was 2.1 degree, and was improved to 1.2 degree after surgery. The interspace angle before surgery, on convex side-bending films, after surgery, at final follow up were 3.2 degrees , -2.3 degrees , 1.8 degrees and 4.9 degrees , respectively. The difference between the interspace angle after surgery and that preoperatively was not significant (P = 0.261), while the interspace angle at final follow-up became larger than that after surgery, and the difference was significant(P = 0.012). The interspace angle after surgery was correlated with that on convex side-bending films (r = 0.418, P = 0.022), and the interspace angle at final follow-up was correlated with that after surgery (r = 0.625, P = 0.000). There was significant correlation between the loss of the interspace angle and the loss of coronal Cobb angle of the main curve during follow-up(r = 0.483, P = 0.007).

Conclusion: The interspace angle could be improved after anterior correction and instrumentation surgery, but it became larger during follow-up. The loss of the interspace angle was correlated with the loss of coronal Cobb angle of the main curve during follow-up.

No MeSH data available.


Related in: MedlinePlus

A 16-year-old female, AIS, PUMC IId1 type. Preoperative X-ray showed a 39° left lumbar curve and a 20° right thoracic curve and the apex of the lumbar curve was located at L2,3 disc. Preoperative lateral X-ray showed no thoracolumbar kyphosis (A, B). The interspace angle between L4 and L5 was 4°. On the right Bending film, the interspace angle was 9° (C). On the left Bending film, it turned to 0° (D). Anterior correction and fusion was performed, and the fusion level was from T12 to L4. Postoperative films showed a good correction and the interspace angle was improved to 0° (E, F). Three-year post-operative follow-up, the interspace angle increased to 2° with also a good coronal balance(G, H).
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Figure 1: A 16-year-old female, AIS, PUMC IId1 type. Preoperative X-ray showed a 39° left lumbar curve and a 20° right thoracic curve and the apex of the lumbar curve was located at L2,3 disc. Preoperative lateral X-ray showed no thoracolumbar kyphosis (A, B). The interspace angle between L4 and L5 was 4°. On the right Bending film, the interspace angle was 9° (C). On the left Bending film, it turned to 0° (D). Anterior correction and fusion was performed, and the fusion level was from T12 to L4. Postoperative films showed a good correction and the interspace angle was improved to 0° (E, F). Three-year post-operative follow-up, the interspace angle increased to 2° with also a good coronal balance(G, H).

Mentions: Thirty patients were included, 4 male, 26 female, with an average age of 14.8 years old (range, 10~18 years). The mean follow-up time was 17.7 months (range, 6~42 months). Single thoracolumbar or lumbar curve 8 cases, thoracic and lumbar curve 22 cases, which included PUMC classification type Ib 3 cases, Ic 5 cases, IIc1 2 cases, IId1 20 cases(Fig. 1). The main curves were toward left in 25 cases and right in 5 cases. We selected combined thoracic and abdominal approach or retroperitoneal approach to perform anterior correction and fusion surgery and standard derotation was performed. The selection of fusion level was according to Hall's principle, and the disc below and above the fusion level should be mobile[7]. The instrumentations included: Texas Scottish Rite Hospital instrument(TSRH) 9 cases, Cotrel-Dubousset Horizon(CDH) 12 cases, Moss-Miami 8 cases, Isola 1 case. The fusion levels were as follows: T10~L2 2 cases, T11~L2 1 case, T10~L3 2 cases, T11~L3 4 cases, T12~L3 15 cases, T12~L4 6 cases. The LIV were located at L2 in 3 patients, L3 in 21 patients and L4 in 6 patients. Thus the interspace angle were located at L2,3 in 3 patients, L3,4 in 21 patients and L4,5 in 6 patients.


The changes of the interspace angle after anterior correction and instrumentation in adolescent idiopathic scoliosis patients.

Wang Y, Qiu G, Yu B, Zhang J, Li J, Weng X, Shen J, Fei Q, Li Q - J Orthop Surg Res (2007)

A 16-year-old female, AIS, PUMC IId1 type. Preoperative X-ray showed a 39° left lumbar curve and a 20° right thoracic curve and the apex of the lumbar curve was located at L2,3 disc. Preoperative lateral X-ray showed no thoracolumbar kyphosis (A, B). The interspace angle between L4 and L5 was 4°. On the right Bending film, the interspace angle was 9° (C). On the left Bending film, it turned to 0° (D). Anterior correction and fusion was performed, and the fusion level was from T12 to L4. Postoperative films showed a good correction and the interspace angle was improved to 0° (E, F). Three-year post-operative follow-up, the interspace angle increased to 2° with also a good coronal balance(G, H).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2198907&req=5

Figure 1: A 16-year-old female, AIS, PUMC IId1 type. Preoperative X-ray showed a 39° left lumbar curve and a 20° right thoracic curve and the apex of the lumbar curve was located at L2,3 disc. Preoperative lateral X-ray showed no thoracolumbar kyphosis (A, B). The interspace angle between L4 and L5 was 4°. On the right Bending film, the interspace angle was 9° (C). On the left Bending film, it turned to 0° (D). Anterior correction and fusion was performed, and the fusion level was from T12 to L4. Postoperative films showed a good correction and the interspace angle was improved to 0° (E, F). Three-year post-operative follow-up, the interspace angle increased to 2° with also a good coronal balance(G, H).
Mentions: Thirty patients were included, 4 male, 26 female, with an average age of 14.8 years old (range, 10~18 years). The mean follow-up time was 17.7 months (range, 6~42 months). Single thoracolumbar or lumbar curve 8 cases, thoracic and lumbar curve 22 cases, which included PUMC classification type Ib 3 cases, Ic 5 cases, IIc1 2 cases, IId1 20 cases(Fig. 1). The main curves were toward left in 25 cases and right in 5 cases. We selected combined thoracic and abdominal approach or retroperitoneal approach to perform anterior correction and fusion surgery and standard derotation was performed. The selection of fusion level was according to Hall's principle, and the disc below and above the fusion level should be mobile[7]. The instrumentations included: Texas Scottish Rite Hospital instrument(TSRH) 9 cases, Cotrel-Dubousset Horizon(CDH) 12 cases, Moss-Miami 8 cases, Isola 1 case. The fusion levels were as follows: T10~L2 2 cases, T11~L2 1 case, T10~L3 2 cases, T11~L3 4 cases, T12~L3 15 cases, T12~L4 6 cases. The LIV were located at L2 in 3 patients, L3 in 21 patients and L4 in 6 patients. Thus the interspace angle were located at L2,3 in 3 patients, L3,4 in 21 patients and L4,5 in 6 patients.

Bottom Line: There was significant correlation between the loss of the interspace angle and the loss of coronal Cobb angle of the main curve during follow-up(r = 0.483, P = 0.007).The interspace angle could be improved after anterior correction and instrumentation surgery, but it became larger during follow-up.The loss of the interspace angle was correlated with the loss of coronal Cobb angle of the main curve during follow-up.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. ypwang@medmail.com.cn

ABSTRACT

Background: In idiopathic scoliosis patients, after anterior spinal fusion and instrumentation, the discs (interspace angle) between the lowest instrumented vertebra (LIV) and the next caudal vertebra became more wedged. We reviewed these patients and analyzed the changes of the angle.

Methods: By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients underwent anterior spinal fusion and instrumentation, Cobb angle of the curve, correction rate, coronal balance, LIV rotation, interspace angle were measured and analyzed.

Results: There were total 30 patients included. The mean coronal Cobb angle of the main curve (thoracolumbar/lumbar curve) before and after surgery were 48.9 degrees and 11.7 degrees , respectively, with an average correction rate of 76.1%. The average rotation of LIV before surgery was 2.1 degree, and was improved to 1.2 degree after surgery. The interspace angle before surgery, on convex side-bending films, after surgery, at final follow up were 3.2 degrees , -2.3 degrees , 1.8 degrees and 4.9 degrees , respectively. The difference between the interspace angle after surgery and that preoperatively was not significant (P = 0.261), while the interspace angle at final follow-up became larger than that after surgery, and the difference was significant(P = 0.012). The interspace angle after surgery was correlated with that on convex side-bending films (r = 0.418, P = 0.022), and the interspace angle at final follow-up was correlated with that after surgery (r = 0.625, P = 0.000). There was significant correlation between the loss of the interspace angle and the loss of coronal Cobb angle of the main curve during follow-up(r = 0.483, P = 0.007).

Conclusion: The interspace angle could be improved after anterior correction and instrumentation surgery, but it became larger during follow-up. The loss of the interspace angle was correlated with the loss of coronal Cobb angle of the main curve during follow-up.

No MeSH data available.


Related in: MedlinePlus