Skip to main content
SpringerLink
Log in

What determines immediate postoperative coronal balance and delayed global coronal balance after anterior spinal fusion for Lenke 5C curves?

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To determine the factors associated with 6-week postoperative global coronal balance and delayed global coronal balance at 2-year follow-up after anterior spinal fusion for Lenke 5C curves.

Methods

A total of 124 consecutive Lenke 5C curves with minimum 2-year follow-up was studied. Radiographic parameters were studied preoperatively, 6 weeks postoperatively, and 2 years postoperatively. Coronal balance was measured by C7-CSVL and trunk shift < 20 mm. The study outcomes were patients with early coronal balance and those who had immediate imbalance but developed delayed balance. Multivariate regression analyses of associated factors were performed with cutoffs determined by receiver operating characteristic curve.

Results

31.5% patients attained global coronal balance immediate postoperatively and 89.4% of the early imbalance cases showed spontaneous coronal balance at 2-year follow-up. Increased preoperative UIV tilt (OR 1.093; p = 0.026; 95% CI: 1.011–1.182) and reduced immediate postoperative RSH difference (OR 0.963; p = 0.015; 95% CI: 0.935–0.993) were associated with immediate postoperative balance. For those with immediate imbalance, larger preoperative major Cobb angle (OR 1.226; p = 0.047; 95% CI: 1.003–1.499), less preoperative C7-CSVL (OR 0.829; p = 0.016; 95% CI: 0.712–0.966), and less immediate postoperative LIV tilt (OR 0.728; p = 0.013; 95% CI: 0.567–0.934) were associated with 2-year coronal balance. There was significant improvement in function (p = 0.006), self-image (p = 0.039) and total score domains (p = 0.014) in immediate imbalance to 2-year balance and imbalance groups.

Conclusion

Successful balance is achieved with a parallel fusion mass when performing anterior spinal fusion for Lenke 5C curves. Patients should be reassured that most attain eventual coronal balance despite the early imbalance.

Level of evidence Therapeutic III

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wang Y, Bunger CE, Zhang Y, Wu C, Li H, Dahl B, Hansen ES (2013) Lowest instrumented vertebra selection for Lenke 5C scoliosis: a minimum 2-year radiographical follow-up. Spine 38:E894-900

    Article  Google Scholar 

  2. Liu Z, Guo J, Zhu Z, Qian B, Sun X, Xu L, Qiu Y (2013) Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion. Eur Spine J 22:2392–2398

    Article  Google Scholar 

  3. Luk KD, Don AS, Chong CS, Wong YW, Cheung KM (2008) Selection of fusion levels in adolescent idiopathic scoliosis using fulcrum bending prediction: a prospective study. Spine 33:2192–2198

    Article  Google Scholar 

  4. Ohrt-Nissen S, Kamath VHD, Samartzis D, Luk KDK, Cheung JPY (2018) Fulcrum flexibility of the main curve predicts postoperative shoulder imbalance in selective thoracic fusion of adolescent idiopathic scoliosis. Eur Spine J 27:2251–2261

    Article  Google Scholar 

  5. Li J, Hwang SW, Shi Z, Yan N, Yang C, Wang C, Zhu X, Hou T, Li M (2011) Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5C patients. Spine 36:1673–1678

    Article  Google Scholar 

  6. Shufflebarger HL, Geck MJ, Clark CE (2004) The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine 29:269–276

    Article  Google Scholar 

  7. Geck MJ, Rinella A, Hawthorne D, Macagno A, Koester L, Sides B, Bridwell K, Lenke L, Shufflebarger H (2009) Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices. Spine 34:1942–1951

    Article  Google Scholar 

  8. Zhao Y, Wang Z, Zhu X, Wang C, He S, Li M (2011) Prediction of postoperative trunk imbalance after posterior spinal fusion with pedicle screw fixation for adolescent idiopathic scoliosis. J Pediatr Orthop B 20:199–208

    Article  Google Scholar 

  9. Shetty AP, Suresh S, Aiyer SN, Kanna R, Rajasekaran S (2017) Radiological factors affecting post-operative global coronal balance in Lenke 5 C scoliosis. J Spine Surg 3:541–547

    Article  Google Scholar 

  10. Cheung JPY, Cheung PWH, Yeng WC, Chan LCK (2020) Does Curve Regression occur during underarm bracing in patients with adolescent idiopathic scoliosis? Clin Orthop Relat Res 478:334–345

    Article  Google Scholar 

  11. Yao G, Cheung JPY, Shigematsu H, Ohrt-Nissen S, Cheung KMC, Luk KDK, Samartzis D (2017) Characterization and predictive value of segmental curve flexibility in adolescent idiopathic scoliosis patients. Spine 42:1622–1628

    Article  Google Scholar 

  12. Shigematsu H, Cheung JP, Bruzzone M, Matsumori H, Mak KC, Samartzis D, Luk KD (2017) Preventing fusion mass shift avoids postoperative distal curve adding-on in adolescent idiopathic scoliosis. Clin Orthop Relat Res 475:1448–1460

    Article  Google Scholar 

  13. Ohrt-Nissen S, Shigematsu H, Cheung JPY, Luk KDK, Samartzis D (2020) Predictability of coronal curve flexibility in postoperative curve correction in adolescent idiopathic scoliosis: the effect of the sagittal profile. Global Spine J 10:303–311

    Article  Google Scholar 

  14. Ohrt-Nissen S, Luk KDK, Samartzis D, Cheung JPY (2020) Selection of the lowest instrumented vertebra in main thoracic adolescent idiopathic scoliosis: Is it safe to fuse shorter than the last touched vertebra? Eur Spine J. https://doi.org/10.1007/s00586-020-06398-4

    Article  PubMed  Google Scholar 

  15. Cheung JPY, Chong CHW, Cheung PWH (2019) Underarm bracing for adolescent idiopathic scoliosis leads to flatback deformity: the role of sagittal spinopelvic parameters. Bone Joint J 101:1370–1378

    Article  Google Scholar 

  16. Eyvazov K, Samartzis D, Cheung JP (2017) The association of lumbar curve magnitude and spinal range of motion in adolescent idiopathic scoliosis: a cross-sectional study. BMC Musculoskelet Disord 18:51

    Article  Google Scholar 

  17. Cheung JPY, Cheung PWH (2020) Supine flexibility predicts curve progression for patients with adolescent idiopathic scoliosis undergoing underarm bracing. Bone Joint J 102:254–260

    Article  Google Scholar 

  18. Cheung JPY, Yiu KKL, Vidyadhara S, Chan PPY, Cheung PWH, Mak KC (2018) Predictability of supine radiographs for determining in-brace correction for adolescent idiopathic scoliosis. Spine 43:971–976

    Article  Google Scholar 

  19. Cheung KM, Luk KD (1997) Prediction of correction of scoliosis with use of the fulcrum bending radiograph. J Bone Joint Surg Am 79:1144–1150

    Article  CAS  Google Scholar 

  20. Klepps SJ, Lenke LG, Bridwell KH, Bassett GS, Whorton J (2001) Prospective comparison of flexibility radiographs in adolescent idiopathic scoliosis. Spine 26:E74-79

    Article  CAS  Google Scholar 

  21. Luk KD, Cheung KM, Lu DS, Leong JC (1998) Assessment of scoliosis correction in relation to flexibility using the fulcrum bending correction index. Spine 23:2303–2307

    Article  CAS  Google Scholar 

  22. Luk KDK, Lu DS, Cheung KMC, Wong YW (2004) A prospective comparison of the coronal deformity correction in thoracic scoliosis using four different instrumentations and the fulcrum-bending radiograph. Spine 29:560–563

    Article  CAS  Google Scholar 

  23. Zhang Y, Lin G, Wang S, Zhang J, Shen J, Wang Y, Guo J, Yang X, Zhao L (2016) higher flexibility and better immediate spontaneous correction may not gain better results for nonstructural thoracic curve in Lenke 5C AIS patients: risk factors for its correction loss. Spine 41:1731–1739

    Article  Google Scholar 

  24. Luk KD, Leong JC, Reyes L, Hsu LC (1989) The comparative results of treatment in idiopathic thoracolumbar and lumbar scoliosis using the Harrington, Dwyer, and Zielke instrumentations. Spine 14:275–280

    Article  CAS  Google Scholar 

  25. Cheung PWH, Wong CKH, Cheung JPY (2019) An insight into the health-related quality of life of adolescent idiopathic scoliosis patients who are braced, observed, and previously braced. Spine 44:E596–E605

    Article  Google Scholar 

  26. Carreon LY, Sanders JO, Diab M, Sucato DJ, Sturm PF, Glassman SD, Spinal Deformity Study G (2010) The minimum clinically important difference in scoliosis research society-22 appearance, activity, and pain domains after surgical correction of adolescent idiopathic scoliosis. Spine 35:2079–2083.

  27. Bursac Z, Gauss CH, Williams DK, Hosmer DW (2008) Purposeful selection of variables in logistic regression. Source Code Biol Med 3:17

    Article  Google Scholar 

  28. Wang Y, Fei Q, Qiu G, Lee CI, Shen J, Zhang J, Zhao H, Zhao Y, Wang H, Yuan S (2008) Anterior spinal fusion versus posterior spinal fusion for moderate lumbar/thoracolumbar adolescent idiopathic scoliosis: a prospective study. Spine 33:2166

    Article  Google Scholar 

  29. Hee HT, Yu ZR, Wong HK (2007) Comparison of segmental pedicle screw instrumentation versus anterior instrumentation in adolescent idiopathic thoracolumbar and lumbar scoliosis. Spine 32:1533–1542

    Article  Google Scholar 

  30. Liljenqvist U, Halm H, Bullmann V (2013) Spontaneous lumbar curve correction in selective anterior instrumentation and fusion of idiopathic thoracic scoliosis of Lenke type C. Eur Spine J 22(Suppl 2):S138-148

    Article  Google Scholar 

  31. Bennett JT, Hoashi JS, Ames RJ, Kimball JS, Pahys JM, Samdani AF (2013) The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves. J Neurosurg Spine 19:658–663

    Article  Google Scholar 

  32. Senkoylu A, Luk KD, Wong YW, Cheung KM (2014) Prognosis of spontaneous thoracic curve correction after the selective anterior fusion of thoracolumbar/lumbar (Lenke 5C) curves in idiopathic scoliosis. Spine J 14:1117–1124

    Article  Google Scholar 

  33. Huitema GC, Jansen RC, van Ooij A, Punt IM, van Rhijn LW (2015) Predictability of spontaneous thoracic curve correction after anterior thoracolumbar correction and fusion in adolescent idiopathic scoliosis. A retrospective study on a consecutive series of 29 patients with a minimum follow-up of 2 years. Spine J 15:966–970

    Article  Google Scholar 

  34. Sudo H, Kaneda K, Shono Y, Iwasaki N (2016) Selection of the upper vertebra to be instrumented in the treatment of thoracolumbar and lumbar adolescent idiopathic scoliosis by anterior correction and fusion surgery using dual-rod instrumentation: a minimum 12-year follow-up study. Spine J 16:281–287

    Article  Google Scholar 

  35. Hurford RK Jr, Lenke LG, Lee SS, Cheng I, Sides B, Bridwell KH (2006) Prospective radiographic and clinical outcomes of dual-rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis: comparison with single-rod constructs. Spine. https://doi.org/10.1097/01.brs.0000238966.75175.2b

    Article  PubMed  Google Scholar 

  36. Nambiar M, Yang Y, Liew S, Turner PL, Torode IP (2016) Single- versus dual-rod anterior instrumentation of thoracolumbar curves in adolescent idiopathic scoliosis. Eur Spine J 25:3249–3255

    Article  Google Scholar 

Download references

Funding

This study was funded by the RGC Research Impact Fund (R5017-18F), the General Research Fund of the Research Grants Council (ref: 17156416), and HKU Seed Fund for basic research (ref: 201910159031).

Author information

Author notes

  1. Abhishek Mannem and Jason Pui Yin Cheung contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China

    Abhishek Mannem, Prudence Wing Hang Cheung & Jason Pui Yin Cheung

  2. Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho Kashihara City, Nara, 6348522, Japan

    Sachiko Kawasaki & Hideki Shigematsu

Authors
  1. Abhishek Mannem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prudence Wing Hang Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sachiko Kawasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideki Shigematsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jason Pui Yin Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AM, PWHC, SK contributed to material preparation, data collection, and analysis. The first draft of the manuscript was written by AM and JPYC. HS and JPYC contributed to the study conception and design. JPYC contributed to funding acquisition, resources, supervision and manuscript revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jason Pui Yin Cheung.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was ethically approved by Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 15–596).

Consent to participate

All patients agreed to study via written informed consent.

Data availability and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mannem, A., Cheung, P.W.H., Kawasaki, S. et al. What determines immediate postoperative coronal balance and delayed global coronal balance after anterior spinal fusion for Lenke 5C curves?. Eur Spine J 30, 2007–2019 (2021). https://doi.org/10.1007/s00586-021-06807-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-06807-2

Keywords

Search

Navigation