title: Selective Thoracic Fusion of Lenke I and II Curves Affects Sagittal Profiles But Not Sagittal or Spinopelvic Alignment: A Case-Control Study.
abstract: METHODS
  Literature review and retrospective case-control study (level 3 evidence) examining 50 adolescent idiopathic scoliosis (AIS) (Lenke I or II curve) cases with 32 healthy controls of the same age. The sagittal profiles were measured preoperatively, 6 months, and 2 years after surgery and compared with those of age-matched controls at baseline.
  
  
  OBJECTIVE
  The purpose of this study is to compare baseline sagittal profiles of AIS Lenke I and II curves with age-matched healthy controls and at 6 months and 2 years after surgery, as well as with previously published reports.
  
  
  BACKGROUND
  Sagittal alignment and profiles have gained significant attention in spinal deformity outcomes. The sagittal profile of patients with AIS has been previously reported, as well as the effects of surgical correction, with inconsistent results and no clear references to nonscoliotic controls.
  
  
  METHODS
  Baseline sagittal profiles of 50 patients presenting with Lenke I or II AIS curves treated with selective thoracic fusion were compared with 32 age-matched controls without spinal pathology. These values were also measured at 6 months and 2 years postoperatively to examine effects of selective thoracic fusion over time. Sagittal parameters examined include pelvic incidence, pelvic tilt, C7 plumb line (sagittal vertical alignment), thoracic kyphosis, and lumbar lordosis. A literature review was performed comparing previously published data. Data are presented as mean (95% confidence interval). P value of less than 0.05 was considered significant.
  
  
  RESULTS
  Interobserver reliability (Cohen κ= 0.49-0.95). All demographic and preoperative sagittal alignment parameters were comparable between controls and patients with AIS prior to surgery. After selective thoracic fusion, thoracic kyphosis decreased significantly from baseline (25.4º [21.6-29.2] vs. 15.3º [12.8-17.8]; P < 0.001) at 6 months and at 2 years (10.3º [7.5-13.1]; P < 0.001). The lumbar lordosis significantly decreased at 6 months from baseline (54.5º [28.6-80.5] vs. 61.8º (33.4-90.1); P < 0.001) and at 2 years (55.4º [29.0-81.9]; P < 0.001). Sagittal vertical alignment, pelvic tilt, and pelvic incidence were comparable between controls and patients with AIS at baseline and did not change with surgery.
  
  
  CONCLUSIONS
  Adolescents with Lenke I or II curves have comparable sagittal profiles with those of healthy controls of the same age. This suggests that Lenke I and II curves may not be hypokyphotic as previously thought. After selective thoracic fusion, patients with AIS have a significantly decreased thoracic kyphosis, which is accompanied by reciprocal changes in the noninstrumented lumbar curve. Sagittal vertical alignment and pelvic tilt are not significantly affected. These results agree with previous reports, which suggest that constructs with pedicle screws have a higher impact on sagittal curves but do not affect sagittal or spinopelvic alignment. The long-term effects of abnormal sagittal profiles need further clarification.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA †University of Iowa Carver College of Medicine, Iowa City, IA; and ‡Department of Physical Medicine and Rehabilitation, Rosalind Franklin University of Medicine and Science, Marianjoy Rehabilitation Hospital, Wheaton, IL.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Ries
authors.forename: Bethany
authors.initials: B
authors.lastname: Harpole
authors.forename: Christopher
authors.initials: C
authors.lastname: Graves
authors.forename: Gnanapradeep
authors.initials: G
authors.lastname: Gnanapragasam
authors.forename: Nyle
authors.initials: N
authors.lastname: Larson
authors.forename: Stuart
authors.initials: S
authors.lastname: Weintstein
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Mendoza-Lattes
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008141:Lordosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011859:Radiography; D020127:Recovery of Function; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome