Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis: How do these two curve types differ?

Vidyadhar V. Upasani, John E Tis, Tracey Bastrom, Jeff Pawelek, Michelle Marks, Baron Lonner, Alvin Crawford, Peter O. Newton

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN. Retrospective chart review and radiographic analysis. OBJECTIVE. To determine if differences exist in the sagittal alignment of adolescent idiopathic scoliosis (AIS) patients with thoracic versus thoracolumbar curve patterns. SUMMARY OF BACKGROUND DATA. Relative anterior overgrowth has been suggested as the possible pathomechanism behind thoracic scoliosis. Given the proposed importance of the sagittal alignment on the development of AIS and the known association between pelvic parameters and sagittal alignment, the authors postulate that pelvic incidence may influence the location of vertebral column collapse associated with different AIS curve types. METHODS. A multicenter surgical database was used to compare preoperative radiographic measurements between patients with primary thoracic curves (Lenke 1A, B), primary thoracolumbar curves (Lenke 5), and normal adolescents. RESULTS. Pelvic incidence was significantly greater in both groups of AIS patients compared with normal adolescents. Patients in the primary thoracic curve group were found to have a significantly increased sacral slope and a decreased thoracic kyphosis relative to the control group. Patients in the primary thoracolumbar curve group had a significantly increased pelvic tilt; however, a relatively normal thoracic kyphosis, lumbar lordosis, and sacral slope compared with the respective control values. CONCLUSION. An increased pelvic incidence, associated with both thoracic and thoracolumbar curves when compared with the normal adolescent population, does not appear to be the potential determinant of the development of thoracic versus thoracolumbar scoliosis, but may be a risk factor for the development of adolescent idiopathic scoliosis. The theory of anterior overgrowth may be supported by the identification of thoracic hypokyphosis, despite an increased pelvic incidence and lumbar lordosis, in patients with thoracic scoliosis. The association between sagittal measurements and the etiology of thoracolumbar curve formation is less clear; however, regional anterior overgrowth in the lumbar spine may also be responsible for the deformity.

Original languageEnglish (US)
Pages (from-to)1355-1359
Number of pages5
JournalSpine
Volume32
Issue number12
DOIs
StatePublished - May 2007
Externally publishedYes

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Scoliosis
Thorax
Adolescent Development
Lordosis
Kyphosis
Incidence
Spine
Databases
Control Groups

Keywords

  • Adolescent idiopathic scoliosis
  • Anterior overgrowth
  • Pelvic and sagittal measurements
  • Thoracic versus thoracolumbar curves

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis : How do these two curve types differ? / Upasani, Vidyadhar V.; Tis, John E; Bastrom, Tracey; Pawelek, Jeff; Marks, Michelle; Lonner, Baron; Crawford, Alvin; Newton, Peter O.

In: Spine, Vol. 32, No. 12, 05.2007, p. 1355-1359.

Research output: Contribution to journalArticle

Upasani, Vidyadhar V. ; Tis, John E ; Bastrom, Tracey ; Pawelek, Jeff ; Marks, Michelle ; Lonner, Baron ; Crawford, Alvin ; Newton, Peter O. / Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis : How do these two curve types differ?. In: Spine. 2007 ; Vol. 32, No. 12. pp. 1355-1359.
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abstract = "STUDY DESIGN. Retrospective chart review and radiographic analysis. OBJECTIVE. To determine if differences exist in the sagittal alignment of adolescent idiopathic scoliosis (AIS) patients with thoracic versus thoracolumbar curve patterns. SUMMARY OF BACKGROUND DATA. Relative anterior overgrowth has been suggested as the possible pathomechanism behind thoracic scoliosis. Given the proposed importance of the sagittal alignment on the development of AIS and the known association between pelvic parameters and sagittal alignment, the authors postulate that pelvic incidence may influence the location of vertebral column collapse associated with different AIS curve types. METHODS. A multicenter surgical database was used to compare preoperative radiographic measurements between patients with primary thoracic curves (Lenke 1A, B), primary thoracolumbar curves (Lenke 5), and normal adolescents. RESULTS. Pelvic incidence was significantly greater in both groups of AIS patients compared with normal adolescents. Patients in the primary thoracic curve group were found to have a significantly increased sacral slope and a decreased thoracic kyphosis relative to the control group. Patients in the primary thoracolumbar curve group had a significantly increased pelvic tilt; however, a relatively normal thoracic kyphosis, lumbar lordosis, and sacral slope compared with the respective control values. CONCLUSION. An increased pelvic incidence, associated with both thoracic and thoracolumbar curves when compared with the normal adolescent population, does not appear to be the potential determinant of the development of thoracic versus thoracolumbar scoliosis, but may be a risk factor for the development of adolescent idiopathic scoliosis. The theory of anterior overgrowth may be supported by the identification of thoracic hypokyphosis, despite an increased pelvic incidence and lumbar lordosis, in patients with thoracic scoliosis. The association between sagittal measurements and the etiology of thoracolumbar curve formation is less clear; however, regional anterior overgrowth in the lumbar spine may also be responsible for the deformity.",
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T2 - How do these two curve types differ?

AU - Upasani, Vidyadhar V.

AU - Tis, John E

AU - Bastrom, Tracey

AU - Pawelek, Jeff

AU - Marks, Michelle

AU - Lonner, Baron

AU - Crawford, Alvin

AU - Newton, Peter O.

PY - 2007/5

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N2 - STUDY DESIGN. Retrospective chart review and radiographic analysis. OBJECTIVE. To determine if differences exist in the sagittal alignment of adolescent idiopathic scoliosis (AIS) patients with thoracic versus thoracolumbar curve patterns. SUMMARY OF BACKGROUND DATA. Relative anterior overgrowth has been suggested as the possible pathomechanism behind thoracic scoliosis. Given the proposed importance of the sagittal alignment on the development of AIS and the known association between pelvic parameters and sagittal alignment, the authors postulate that pelvic incidence may influence the location of vertebral column collapse associated with different AIS curve types. METHODS. A multicenter surgical database was used to compare preoperative radiographic measurements between patients with primary thoracic curves (Lenke 1A, B), primary thoracolumbar curves (Lenke 5), and normal adolescents. RESULTS. Pelvic incidence was significantly greater in both groups of AIS patients compared with normal adolescents. Patients in the primary thoracic curve group were found to have a significantly increased sacral slope and a decreased thoracic kyphosis relative to the control group. Patients in the primary thoracolumbar curve group had a significantly increased pelvic tilt; however, a relatively normal thoracic kyphosis, lumbar lordosis, and sacral slope compared with the respective control values. CONCLUSION. An increased pelvic incidence, associated with both thoracic and thoracolumbar curves when compared with the normal adolescent population, does not appear to be the potential determinant of the development of thoracic versus thoracolumbar scoliosis, but may be a risk factor for the development of adolescent idiopathic scoliosis. The theory of anterior overgrowth may be supported by the identification of thoracic hypokyphosis, despite an increased pelvic incidence and lumbar lordosis, in patients with thoracic scoliosis. The association between sagittal measurements and the etiology of thoracolumbar curve formation is less clear; however, regional anterior overgrowth in the lumbar spine may also be responsible for the deformity.

AB - STUDY DESIGN. Retrospective chart review and radiographic analysis. OBJECTIVE. To determine if differences exist in the sagittal alignment of adolescent idiopathic scoliosis (AIS) patients with thoracic versus thoracolumbar curve patterns. SUMMARY OF BACKGROUND DATA. Relative anterior overgrowth has been suggested as the possible pathomechanism behind thoracic scoliosis. Given the proposed importance of the sagittal alignment on the development of AIS and the known association between pelvic parameters and sagittal alignment, the authors postulate that pelvic incidence may influence the location of vertebral column collapse associated with different AIS curve types. METHODS. A multicenter surgical database was used to compare preoperative radiographic measurements between patients with primary thoracic curves (Lenke 1A, B), primary thoracolumbar curves (Lenke 5), and normal adolescents. RESULTS. Pelvic incidence was significantly greater in both groups of AIS patients compared with normal adolescents. Patients in the primary thoracic curve group were found to have a significantly increased sacral slope and a decreased thoracic kyphosis relative to the control group. Patients in the primary thoracolumbar curve group had a significantly increased pelvic tilt; however, a relatively normal thoracic kyphosis, lumbar lordosis, and sacral slope compared with the respective control values. CONCLUSION. An increased pelvic incidence, associated with both thoracic and thoracolumbar curves when compared with the normal adolescent population, does not appear to be the potential determinant of the development of thoracic versus thoracolumbar scoliosis, but may be a risk factor for the development of adolescent idiopathic scoliosis. The theory of anterior overgrowth may be supported by the identification of thoracic hypokyphosis, despite an increased pelvic incidence and lumbar lordosis, in patients with thoracic scoliosis. The association between sagittal measurements and the etiology of thoracolumbar curve formation is less clear; however, regional anterior overgrowth in the lumbar spine may also be responsible for the deformity.

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KW - Anterior overgrowth

KW - Pelvic and sagittal measurements

KW - Thoracic versus thoracolumbar curves

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