How to Determine the Upper Level of Instrumentation in Lenke Types 1 and 2 Adolescent Idiopathic Scoliosis
| Autor: | Yan Lefevre, Franck Fitoussi, Brice Ilharreborde, Georges-François Penneçot, Philippe Souchet, Keyvan Mazda, Ana Presedo, Julien Even |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Shoulder medicine.medical_specialty Adolescent Radiography Arthrodesis medicine.medical_treatment Scoliosis Thoracic Vertebrae medicine Humans Orthopedics and Sports Medicine Prospective Studies Postural Balance Device Removal Rachis Orthodontics business.industry General Medicine medicine.disease Clavicle Sagittal plane Surgery Spinal Fusion Treatment Outcome medicine.anatomical_structure Coronal plane Pediatrics Perinatology and Child Health Orthopedic surgery Female business Software Follow-Up Studies |
| Zdroj: | Journal of Pediatric Orthopaedics. 28:733-739 |
| ISSN: | 0271-6798 |
| DOI: | 10.1097/bpo.0b013e318185a36b |
| Popis: | Background The selection of fusion levels continues to be controversial in adolescent idiopathic scoliosis (AIS). The classifications of King and Lenke remain the most widely used, but recent studies have demonstrated their shortcomings, including poor interobserver reproducibility. We propose a method of preoperative planning that is independent of anatomical classifications, based on the anticipated effect of curve reduction. The objectives of this preoperative strategy are (1) to achieve satisfactory T1 tilt and shoulder balance and (2) to restore balance in the coronal and sagittal planes. The purpose of the present study was to evaluate the results of our strategy of deciding the proximal level of arthrodesis in Lenke types 1 and 2 AIS. Methods We included 132 adolescents operated on for thoracic AIS by posterior instrumentation. The choice of the proximal fusion level was based on preoperative analysis of the rigidity of the proximal curvature, T1 tilt, and shoulder balance. The preoperative, postoperative, and last follow-up radiographs were digitized then analyzed using computer software. Radiological parameters were compared using paired t tests. Results Average age at the time of surgery was 15.2 years (SD, 1.7 years). Mean follow-up was 30.2 months. The clavicle angle and T1 tilt were significantly improved in both Lenke types 1 and 2 curves. No correlation was found between T1 tilt and shoulder balance. At last follow-up, 89% of the patients satisfied all criteria for balance. Conclusions The results of the present preoperative strategy, to which we adhered in 97% of cases, are encouraging and show that the systematic instrumentation of the entire proximal curvature is not justified in Lenke type 2 curves. However, long-term consequences of the residual T1 tilt need to be studied further. |
| Databáze: | OpenAIRE |
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