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Research ArticleBiomechanics

Impact of Different Operative Techniques for Patients With Adolescent Idiopathic Scoliosis on Frontal Curve Correction and Sagittal Balance

Max Prost, Philip Denz, Joachim Windolf and Markus Rafael Konieczny
International Journal of Spine Surgery May 2024, 8602; DOI: https://doi.org/10.14444/8602
Max Prost
1 Department of Orthopedic and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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  • For correspondence: Max.prost@med.uni-duesseldorf.de
Philip Denz
1 Department of Orthopedic and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Joachim Windolf
1 Department of Orthopedic and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Markus Rafael Konieczny
1 Department of Orthopedic and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
2 Department of Spine Surgery, Volmarstein Orthopedic Clinic, Volmarstein, Germany
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  • Figure 1
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    Figure 1

    Example full-spine radiographs of a patient treated with selective fusion (A, presurgery and B, postsurgery) and a patient treated with nonselective fusion (C, presurgery and D, postsurgery).

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    Figure 2

    Example full-spine radiographs of a patient treated with hybrid-technique with screws, hooks, and tapes (A, presurgery and B, postsurgery); a patient treated with hybrid-technique with screws and hooks (C, presurgery and D, postsurgery); and a patient treated with all-screw technique (E, presurgery and F, postsurgery).

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    Figure 3

    Measurement of the Cobb angle from the main curve and the upper and lower minor curve in a posterior-anterior view of a full-spine radiograph.

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    Figure 4

    Measurement of the pelvic incidence in a lateral lumbar spine radiograph.

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    Figure 5

    Measurement of parameters from the sagittal profile. (A) Measurement of the lumbar lordosis between L1 and S1 in a lateral lumbar spine radiograph. (B) Measurement of the thoracic kyphosis between T1 and T12 as well as between T5 and Th12 in a lateral thoracic spine radiograph.

Tables

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    Table 1

    Inclusion and exclusion criteria.

    CriteriaInclusionExclusion
    TreatmentSurgical treatment by posterior instrumented fusionAdditional anterior surgical procedure or previous treatment with a growing rod system
    Scoliosis typeAdolescent idiopathic scoliosisNonidiopathic scoliosis (ie, early-onset or neuromuscular)
    Data setComplete set of data including full spine x-rays in posterior-anterior and lateral views before and after surgery and at end of follow-upIncomplete set of data
    Follow-up≥24 months<24 months
    • View popup
    Table 2

    Lenke classification of included patients (N = 55).

    Type of Curve n %
    12138.2
    22138.2
    323.6
    435.5
    5712.7
    611.8
    • View popup
    Table 3

    Cobb angles of the main and minor curve in the pre- and postoperative radiographs and the perioperative correction of the Cobb angle by the different techniques.

    TechniquePreoperative Cobb Angle, °Postoperative Cobb Angle, °Correction of Cobb Angle, ° (%)
    Main CurveMinor CurveMain CurveMinor CurveMain CurveMinor Curve
    All
     Mean 57.26 42.23 27.95 22.20 30.33 (52.9) 20.03 (47.4)
     SEM 1.81 1.81 1.60 1.49 1.45 1.74
    SF
     Mean 55.50 34.36 27.43 22.93 27.53 (49.6) 15.10 (43.9)
     SEM 2.15 1.50 1.83 1.90 1.61 1.60
    NSF
     Mean 59.72 43.99 28.37 21.18 31.35 (52.3) 26.90 (61.2)
     SEM 3.00 3.47 2.68 2.34 2.36 2.92
    HTH
     Mean 61.57 44.00 28.57 20.12 33.00 (53.6) 25.94 (59.0)
     SEM 3.18 3.55 2.87 2.38 2.41 3.36
    HTHT
     Mean 53.37 33.52 26.46 22.63 26.22 (48.9) 16.58 (49.5)
     SEM 1.86 1.83 1.72 1.87 1.66 1.65
    AS
     Mean 57.59 38.15 30.05 26.58 27.54 (47.8) 14.58 (38.2)
     SEM 5.46 2.62 4.48 4.74 3.36 2.89
    • Abbreviations: AS, all screws technique; HTH, hybrid technique with screws and hooks; HTHT, hybrid technique with screws, hooks, and tapes; NSF, nonselective fusion; SF, selective fusion.

    • View popup
    Table 4

    Difference between preoperative and postoperative LL and PI for the different techniques.

    TechniquePreoperativePostoperativePre- and Postoperative
    All
     Mean 5.8073 4.1262 1.3875
     SEM 1.94256 2.39210 2.46151
    NSF
     Mean 6.54 0.36 6.18
     SEM 3.25 3.78 3.34
    SF
     Mean 5.47 5.81 -0.92
     SEM 1.83 2.39 2.56
    • Abbreviations: LL, lumbar lordosis; PI, pelvic incidence.

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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Impact of Different Operative Techniques for Patients With Adolescent Idiopathic Scoliosis on Frontal Curve Correction and Sagittal Balance
Max Prost, Philip Denz, Joachim Windolf, Markus Rafael Konieczny
International Journal of Spine Surgery May 2024, 8602; DOI: 10.14444/8602

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Impact of Different Operative Techniques for Patients With Adolescent Idiopathic Scoliosis on Frontal Curve Correction and Sagittal Balance
Max Prost, Philip Denz, Joachim Windolf, Markus Rafael Konieczny
International Journal of Spine Surgery May 2024, 8602; DOI: 10.14444/8602
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Keywords

  • scoliosis
  • Selective Fusion
  • Treatment Strategies
  • frontal profile
  • sagittal profile

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