Abstract
Methods Study Design: Retrospective observational study. Population: A total of 23 patients (15 males; 8 females), aged 11 to 17 years were included. Each patient had at least two clinical evaluations and spinal X rays (lateral projection) at the time of therapy start (T0) and stop (T1). Methods: 20 patients presented thoracic hyperkyphosis and three presented thoracolumbar kyphosis. All of the patients were treated conservatively; specifically, 17 were treated with brace plus specific exercises and 6 were treated with only specific exercises. For all of the patients we measured the sagittal parameters of thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and spinosacral angle (SSA). Statistical analysis: paired Wilcoxon test and correlation (Pearson). Results Mean and standard deviation for each parameter were measured in T0: TK, LL, PI 43.83± 7.95, PT 4.83± 6.96, SS 38.91± 7.67, SSA; and in T1: TK, LL, PI 41.87± 9.62, PT 5.48± 7.04, SS 36.39± 7.80, SSA. Highly significant improvements were found for the main spinal parameters from T0 to T1: TK reduced from 54.22± 13.58 to 44.48± 12.80 (p= 0.0006), LL from 57.43± 11.16 to 51.13± 10.28 (p= 0.0077) and SSA from 132.87± 9.80 to 127.09± 9.24 (p= 0.0036); no significant differences were found for the other parameters. Looking at sagittal parameter correlations,very few were found at the start of treatment: SS correlated with LL (R=0.651; p=0,007), SSA (R=0.600; p=0.0025) and PI (R=0.596; p=0.0027) which also correlated with PT (R=0.515; p=0.0119). Contrarily, at the end of treatment, most parameters were correlated: LL with PI ( R=0.514; p=0.0122), SS (R=0.499; p=0.0152), and SSA (R=0.743; p<0.0001), PI with PT(R=0.600; p=0.0024), SS (R= 0.691; p=0.0003) and SSA (R=0.628; p=0.0013) and SS with SSA (R=0.650; p=0.0008).
Highlights
Sagittal alignment of the spine is not well understood
Mean and standard deviation for each parameter were measured in T0: thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI) 43.83± 7.95, pelvic tilt (PT) 4.83± 6.96, sacral slope (SS) 38.91± 7.67, spinosacral angle (SSA); and in T1: TK, LL, PI 41.87± 9.62, PT 5.48± 7.04, SS 36.39± 7.80, SSA
Significant improvements were found for the main spinal parameters from T0 to T1: TK reduced from 54.22± 13.58 to 44.48± 12.80 (p= 0.0006), LL from 57.43± 11.16 to 51.13± 10.28 (p= 0.0077) and SSA from 132.87± 9.80 to 127.09± 9.24 (p= 0.0036); no significant differences were found for the other parameters
Summary
Sagittal alignment of the spine is not well understood. Some authors have demonstrated that the spinal shape is closely correlated with the pelvic shape and orientation. Uncertainty exists if pathological kyphosis should be treated, regardless of sagittal balance. Purpose The goal of this study was to assess how conservative treatment of pathological kyphosis during growth correlates with spinal and pelvic sagittal balance parameters
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