Abstract
BackgroundTo date, no study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients. The purpose of this study is to evaluate the cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder treated by either full fusion or partial/non fusion of the proximal thoracic curve.MethodsA total of 30 Lenke type 2 AIS patients with preoperative right-elevated shoulder underwent posterior spinal instrumentation from 2009 to 2011 were included in this study. All the subjects were divided into 2 groups according to the selection of upper instrumented vertebra. There were 14 cases proximally fused to T1 or T2 (Group A) and 16 cases proximally fused to T3 or below (Group B). Both standing anteroposterior and sagittal X-ray films of the spine obtained preoperatively, one week after the operation, and at a minimum of two-year follow-up were analyzed with respect to the following parameters: cervical tilt, T1 tilt, proximal thoracic Cobb angle, main thoracic Cobb angle, apical vertebral translation of proximal thoracic curve, apical vertebral translation of main thoracic curve, radiographic shoulder height, cervical lordosis, proximal thoracic kyphosis and main thoracic kyphosis.ResultsMost (83.3%) of the patients in these two groups gained satisfactory shoulder balance after surgery. However, the cervical tilt significantly improved in group A (p < 0.001) but deteriorated in group B (p < 0.001). In group A, the decrease of cervical tilt significantly positively correlated with that of T1 tilt (p < 0.001). In group B, the increase of cervical tilt significantly positively correlated with both the increase of T1 tilt (p < 0.001) and the increase of apical vertebral translation of proximal thoracic curve (p < 0.05).ConclusionsLenke type 2 AIS patients with right-elevated shoulder gain improved shoulder but deteriorated cervical tilt after partial/non fusion of proximal thoracic curve. Full fusion of proximal thoracic curve helps to prevent the residual cervical tilt in these patients.
Highlights
To date, no study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients
Nowadays, it had been widely accepted that whether the proximal thoracic (PT) curve should be fused in adolescent idiopathic scoliosis (AIS) patients depended on both the flexibility of PT curve and the directionality of preoperative shoulder height [1, 2]
The PT curve had poor flexibility in Lenke type 2 AIS patients with low spontaneous correction ability in case of sole correction of main thoracic (MT) curve [3]. Both PT curve and MT curve should be fused if the Lenke type 2 AIS patient had a preoperative left-elevated shoulder since sole correction of the right MT curve could further elevate the left shoulder, which might lead to deterioration of the shoulder imbalance [4, 5]
Summary
No study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients. The purpose of this study is to evaluate the cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder treated by either full fusion or partial/non fusion of the proximal thoracic curve. The PT curve had poor flexibility in Lenke type 2 AIS patients with low spontaneous correction ability in case of sole correction of main thoracic (MT) curve [3] Both PT curve and MT curve should be fused if the Lenke type 2 AIS patient had a preoperative left-elevated shoulder since sole correction of the right MT curve could further elevate the left shoulder, which might lead to deterioration of the shoulder imbalance [4, 5]. This study aims to evaluate the postoperative cervical tilt in AIS patients with double thoracic curve treated by either full fusion or partial/non fusion of the PT curve and to analyze the mechanism underlying this phenomenon with the purpose of aiding spine surgeons with preoperative planning
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