Thoracic Kyphosis and Lumbar Lordosis Distribution After Idiopathic Scoliosis Correction Using Posterior Hybrid Versus Screw Instrumentation.

STUDY DESIGN

This was a retrospective observational study.

OBJECTIVE

The aim of this study was to evaluate kyphosis and lordosis distribution, inflexion points, and the relationship with proximal junctional kyphosis (PJK) comparing hybrid instrumentation (in situ contouring, derotation) versus screw instrumentation (thoracic cantilever reduction, lumbar in situ contouring, and derotation).

SUMMARY OF BACKGROUND DATA

The combination of reduction techniques aims at restoring the levels of lumbar apex and thoracolumbar inflexion point according to Roussouly alignment types. This approach could minimize the PJK risk after adolescent idiopathic scoliosis (AIS) surgery.

MATERIALS AND METHODS

The study assessed coronal curve correction, thoracolumbar and spinopelvic sagittal parameters in 86 skeletally mature adolescents and young adults 2.2 years after AIS correction, comparing a hybrid group (HG, n=34) to a screw group (SG, n=52). Segmental kyphosis and lordosis distribution, number of vertebrae included in curves, thoracic and lumbar apex, thoracolumbar inflexion point and Roussouly types were modeled using KEOPS software.

RESULTS

Global coronal and sagittal correction were similar in both groups. In the SG, lumbar lordosis (LL) decreased from 61.1 to 53.9 degrees (P<0.0001) and matched with pelvic incidence (r=0.69), whereas LL did not change in the HG. Postoperatively, the thoracolumbar inflexion point migrated cranially, resulting in a longer LL in both groups. Postoperative thoracolumbar inflexion point (P<0.0001) and the lumbar apex (P=0.0274) were more caudal in the SG compared with the HG. The PJK rate was 14.7% in the HG and 7.7% in the SG. In patients with PJK, lumbar apex and thoracolumbar inflexion point shifted cranially and were too high according to the Roussouly type.

CONCLUSIONS

Hybrid and screw instrumentation led to similar global AIS correction, but the use of cantilever reduction in the SG allowed setting the thoracolumbar inflexion point and the lumbar apex lower than in the HG. Cranial migration of these points was identified as PJK risk factor.

LEVEL OF EVIDENCE

Level III.