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Predictability of the spontaneous lumbar curve correction after selective thoracic fusion in idiopathic scoliosis.

Jansen RC, van Rhijn LW, Duinkerke E, van Ooij A - Eur Spine J (2007)

Bottom Line: The lumbar curve correction does not occur throughout the whole lumbar curve.Most correction is achieved in the upper part of the curve.The distal lumbar curve seems to be more rigid and less important in the spontaneous curve correction.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. robjansen_80@yahoo.com

ABSTRACT
In this study we tried to achieve a better understanding of the biodynamic mechanism of balance in the scoliotic spine. Therefore we focused on the pre- and postoperative spine of patients with idiopathic scoliosis with a primary thoracic curve and a secondary lumbar curve. Several studies showed that the lumbar curve spontaneously corrects and improves after selective thoracic fusion. We try to understand and describe this spontaneous compensatory lumbar curve correction after selective thoracic correction and fusion. We performed a retrospective examination of pre- and postoperative radiographs of the spine of 38 patients with idiopathic scoliosis King type II and III. Frontal Cobb angles of the thoracic and lumbar curves were assessed on pre- and postoperative antero-posterior and side bending radiographs. We determined the postoperative corrections of the thoracic and lumbar curves. Relative (%) corrections and correlations of the postoperative corrections were calculated. The group was divided in three subgroups, depending on lumbar curve modifier, according to Lenkes classification system. The calculations were done for the whole group as for each subgroup. As expected, significant correlations were present between the relative correction of the main thoracic and the lumbar curve (mean R = 0.590; P = 0.001). The relation between relative thoracic and lumbar correction decreased with the lumbar modifier type. This study shows a highly significant correlation between the relative corrections of the main thoracic curve and the lumbar curve after selective thoracic fusion in idiopathic scoliosis. This correlation depends on lumbar curve modifier type. This new classification system seems to be of great predictable value for the spontaneous correction of the lumbar curve. Depending on the curve-type, a different technique for predicting the outcome should be used. The lumbar curve correction does not occur throughout the whole lumbar curve. Most correction is achieved in the upper part of the curve. The distal lumbar curve seems to be more rigid and less important in the spontaneous curve correction.

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Correlation of relative (%) correction between the main thoracic (MT) curve and the lumbar curve (R = 0.590; P = 0.001)
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Fig1: Correlation of relative (%) correction between the main thoracic (MT) curve and the lumbar curve (R = 0.590; P = 0.001)

Mentions: In order to find a correlation between the correction of the main thoracic and lumbar curves, we used the relative (%) corrections of the curves (Table 5). One year postoperatively, we found a weak but highly significant correlation between relative thoracic and lumbar curve correction for the whole group (R = 0.590; P < 0.001) (Fig. 1). The correlation coefficient between the relative correction of the thoracic and lumbar curve seems to decrease with the lumbar modifier (A, B, C) (Table 5). For lumbar modifier A, the correlation is strongest (R = 0.698; P = 0.004).Table 5


Predictability of the spontaneous lumbar curve correction after selective thoracic fusion in idiopathic scoliosis.

Jansen RC, van Rhijn LW, Duinkerke E, van Ooij A - Eur Spine J (2007)

Correlation of relative (%) correction between the main thoracic (MT) curve and the lumbar curve (R = 0.590; P = 0.001)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2200742&req=5

Fig1: Correlation of relative (%) correction between the main thoracic (MT) curve and the lumbar curve (R = 0.590; P = 0.001)
Mentions: In order to find a correlation between the correction of the main thoracic and lumbar curves, we used the relative (%) corrections of the curves (Table 5). One year postoperatively, we found a weak but highly significant correlation between relative thoracic and lumbar curve correction for the whole group (R = 0.590; P < 0.001) (Fig. 1). The correlation coefficient between the relative correction of the thoracic and lumbar curve seems to decrease with the lumbar modifier (A, B, C) (Table 5). For lumbar modifier A, the correlation is strongest (R = 0.698; P = 0.004).Table 5

Bottom Line: The lumbar curve correction does not occur throughout the whole lumbar curve.Most correction is achieved in the upper part of the curve.The distal lumbar curve seems to be more rigid and less important in the spontaneous curve correction.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. robjansen_80@yahoo.com

ABSTRACT
In this study we tried to achieve a better understanding of the biodynamic mechanism of balance in the scoliotic spine. Therefore we focused on the pre- and postoperative spine of patients with idiopathic scoliosis with a primary thoracic curve and a secondary lumbar curve. Several studies showed that the lumbar curve spontaneously corrects and improves after selective thoracic fusion. We try to understand and describe this spontaneous compensatory lumbar curve correction after selective thoracic correction and fusion. We performed a retrospective examination of pre- and postoperative radiographs of the spine of 38 patients with idiopathic scoliosis King type II and III. Frontal Cobb angles of the thoracic and lumbar curves were assessed on pre- and postoperative antero-posterior and side bending radiographs. We determined the postoperative corrections of the thoracic and lumbar curves. Relative (%) corrections and correlations of the postoperative corrections were calculated. The group was divided in three subgroups, depending on lumbar curve modifier, according to Lenkes classification system. The calculations were done for the whole group as for each subgroup. As expected, significant correlations were present between the relative correction of the main thoracic and the lumbar curve (mean R = 0.590; P = 0.001). The relation between relative thoracic and lumbar correction decreased with the lumbar modifier type. This study shows a highly significant correlation between the relative corrections of the main thoracic curve and the lumbar curve after selective thoracic fusion in idiopathic scoliosis. This correlation depends on lumbar curve modifier type. This new classification system seems to be of great predictable value for the spontaneous correction of the lumbar curve. Depending on the curve-type, a different technique for predicting the outcome should be used. The lumbar curve correction does not occur throughout the whole lumbar curve. Most correction is achieved in the upper part of the curve. The distal lumbar curve seems to be more rigid and less important in the spontaneous curve correction.

Show MeSH
Related in: MedlinePlus