Bone Remodeling and Disc Morphology in the Distal Unfused Spine After Spinal Fusion in Adolescent Idiopathic Scoliosis

Abstract

BackgroundMorphologic changes in the vertebral body in adolescent idiopathic scoliosis (AIS) have been associated with curve development and progression. Yet, after an AIS spinal surgery, the impact of the global and local spinal realignment on the vertebral body and intervertebral disc morphologic changes, particularly in the distal unfused spine, have not been determined. Questions/PurposesTo determine the changes in the unfused lumbar vertebrae and disc morphology two years after spinal fusion in AIS patients undergoing selective thoracic fusion (STF). Patients and MethodsA total of 58 patients with Lenke type 1 AIS who underwent STF with a minimum two-year follow-up and 20 nonscoliotic adolescents were included. Biplanar stereoradiography of the spine at preoperative, early postoperative, and two-year follow-up were used to generate 3D models of the spine. Lumbar spine vertebral and intervertebral heights (anterior, posterior, left, and right) and the degree of wedging in the frontal and sagittal plane were calculated in the local coordinate system of the vertebral bodies. The morphology of vertebrae and discs were compared between the pre- and postoperative visits of AIS patients and nonscoliotic controls. ResultsLumbar lordosis was not statistically different between the pre- and post-operative AIS and controls, p > .05. The contribution of the lumbar vertebral bodies and discs' sagittal wedging to the total L1–L5 lordosis were 20% and 80%, respectively, for nonscoliotic controls and 61% and 39%, respectively, for AIS patients at two-year follow-up. The decrease in the anterior and left heights of the disc between the preoperative and two-year follow-up was significant, p < .05. ConclusionPatients undergoing STF for Lenke 1 AIS are able to achieve normal lumbar lordosis after surgery but seem to regain their sagittal alignment by morphologic changes in the disc more so than the vertebral body. A larger contribution of the vertebral sagittal wedging to the total lumbar lordosis at two years post STF was observed when these variables were compared to the nonscoliotic adolescents. Level of EvidenceLevel IV.