Pelvic incidence correlates to sagittal spinal morphology in lenke 5 adolescent idiopathic scoliosis and influences the proximal junctional kyphosis rate after correction surgery

Abstract

This study aimed to investigate the relationship between pelvic incidence and sagittal spinal morphology in Lenke 5 adolescent idiopathic scoliosis (AIS) and its impact on the proximal junctional kyphosis rate after surgery. The study enrolled a total of 52 cases of Lenke 5 AIS between September 2009 and December 2018. Sagittal spinal morphological parameters, pelvic incidence (PI) and the proximal junctional angle were measured on full-length spinal standing lateral x-ray films preoperatively, postoperatively and at the final follow-up. Pearson correlation analysis was performed to reveal the relationship between sagittal spinal morphology and PI. Multivariable regression analysis and receiver operating characteristic (ROC) curve analysis were performed to identify the risk factors for proximal junctional kyphosis (PJK). A correlation was found between PI and sagittal spinal morphological parameters, but not between PI and lumbar lordosis. The PJK rate after surgery was 23% (12/52). PI was revealed as an independent risk factor for proximal junctional kyphosis according to multivariable regression analysis (OR = 0.902, p = 0.049). Both multivariable regression analysis and ROC curve analysis verified that restoring a rational postoperative PI-LL/PLL relationship reduced the rate of PJK, including PI-LL mismatch (OR = 0.743, p = 0.046; cutoff value = - 15.5°), the LL-PI ratio (OR = 5.756, p = 0.021; cutoff value = 1.09), and the PLL-PI ratio (OR = 2.116, p = 0.016; cutoff value = 0.40). PI influences sagittal spinal morphology in Lenke 5 AIS, although it does not show an inherent relationship with lumbar lordosis. PI also correlates to the PJK rate after surgery. Restoring an ideal postoperative PI-LL relationship could decrease the PJK rate.