Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implications
Abstract Background The uniqueness of spinal sagittal alignment in thoracic adolescent idiopathic scoliosis (AIS), for example, the drastically smaller thoracic kyphosis seen in some patients, has been recognized but not yet fully understood. The purpose of this study was to clarify the characterist...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-022-05379-6 |
| _version_ | 1818189936381132800 |
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| author | Takuya Iimura Haruki Ueda Satoshi Inami Hiroshi Moridaira Daisaku Takeuchi Hiromichi Aoki Hiroshi Taneichi |
| author_facet | Takuya Iimura Haruki Ueda Satoshi Inami Hiroshi Moridaira Daisaku Takeuchi Hiromichi Aoki Hiroshi Taneichi |
| author_sort | Takuya Iimura |
| collection | DOAJ |
| description | Abstract Background The uniqueness of spinal sagittal alignment in thoracic adolescent idiopathic scoliosis (AIS), for example, the drastically smaller thoracic kyphosis seen in some patients, has been recognized but not yet fully understood. The purpose of this study was to clarify the characteristics of sagittal alignment of thoracic AIS and to determine the contributing factors. Methods Whole spine radiographs of 83 thoracic AIS patients (73 females) were analyzed. The measured radiographic parameters were the Cobb angle of thoracic scoliosis, thoracic kyphosis (TK), lumbar lordosis (LL), C7 sagittal vertical axis (C7 SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Additionally, max-LL, which was defined as the maximum lordosis angle from the S1 endplate, the inflection point between thoracic kyphosis and lumbar lordosis, and the SVA of the inflection point (IP SVA) were measured. The factors significantly related to a decrease in TK were assessed by stepwise logistic regression analysis. In addition, cluster analysis was performed to classify the global sagittal alignment. Results The significant factors for a decrease in TK were an increase in SS (p = 0.0003, [OR]: 1.16) and a decrease in max-LL (p = 0.0005, [OR]: 0.89). According to the cluster analysis, the global sagittal alignment was categorized into the following three types: Type 1 (low SS, low max-LL, n = 28); Type 2 (high SS, low max-LL, n = 22); and Type 3 (high SS, high max-LL, n = 33). Conclusions In thoracic AIS, a decreased TK corresponded to an increased SS or a decreased max-LL. The sagittal alignment of thoracic AIS patients could be classified into three types based on SS and max-LL. One of these three types includes the unique sagittal profile of very small TK. |
| first_indexed | 2024-12-11T23:50:44Z |
| format | Article |
| id | doaj.art-0ceb60882ca94a7fae824373d6ffa0a9 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-11T23:50:44Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-0ceb60882ca94a7fae824373d6ffa0a92022-12-22T00:45:29ZengBMCBMC Musculoskeletal Disorders1471-24742022-05-012311810.1186/s12891-022-05379-6Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implicationsTakuya Iimura0Haruki Ueda1Satoshi Inami2Hiroshi Moridaira3Daisaku Takeuchi4Hiromichi Aoki5Hiroshi Taneichi6Department of Orthopaedic Surgery, Dokkyo Medical UniversityDepartment of Orthopaedic Surgery, Dokkyo Medical UniversityDepartment of Orthopaedic Surgery, Dokkyo Medical UniversityDepartment of Orthopaedic Surgery, Dokkyo Medical UniversityDepartment of Orthopaedic Surgery, Dokkyo Medical UniversityDepartment of Orthopaedic Surgery, Dokkyo Medical UniversityDepartment of Orthopaedic Surgery, Dokkyo Medical UniversityAbstract Background The uniqueness of spinal sagittal alignment in thoracic adolescent idiopathic scoliosis (AIS), for example, the drastically smaller thoracic kyphosis seen in some patients, has been recognized but not yet fully understood. The purpose of this study was to clarify the characteristics of sagittal alignment of thoracic AIS and to determine the contributing factors. Methods Whole spine radiographs of 83 thoracic AIS patients (73 females) were analyzed. The measured radiographic parameters were the Cobb angle of thoracic scoliosis, thoracic kyphosis (TK), lumbar lordosis (LL), C7 sagittal vertical axis (C7 SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Additionally, max-LL, which was defined as the maximum lordosis angle from the S1 endplate, the inflection point between thoracic kyphosis and lumbar lordosis, and the SVA of the inflection point (IP SVA) were measured. The factors significantly related to a decrease in TK were assessed by stepwise logistic regression analysis. In addition, cluster analysis was performed to classify the global sagittal alignment. Results The significant factors for a decrease in TK were an increase in SS (p = 0.0003, [OR]: 1.16) and a decrease in max-LL (p = 0.0005, [OR]: 0.89). According to the cluster analysis, the global sagittal alignment was categorized into the following three types: Type 1 (low SS, low max-LL, n = 28); Type 2 (high SS, low max-LL, n = 22); and Type 3 (high SS, high max-LL, n = 33). Conclusions In thoracic AIS, a decreased TK corresponded to an increased SS or a decreased max-LL. The sagittal alignment of thoracic AIS patients could be classified into three types based on SS and max-LL. One of these three types includes the unique sagittal profile of very small TK.https://doi.org/10.1186/s12891-022-05379-6Thoracic AISSagittal alignmentHypokyphosisSacral slopeMax-LLInflection point |
| spellingShingle | Takuya Iimura Haruki Ueda Satoshi Inami Hiroshi Moridaira Daisaku Takeuchi Hiromichi Aoki Hiroshi Taneichi Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implications BMC Musculoskeletal Disorders Thoracic AIS Sagittal alignment Hypokyphosis Sacral slope Max-LL Inflection point |
| title | Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implications |
| title_full | Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implications |
| title_fullStr | Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implications |
| title_full_unstemmed | Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implications |
| title_short | Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implications |
| title_sort | thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis recognition of thoracic hypokyphosis and therapeutic implications |
| topic | Thoracic AIS Sagittal alignment Hypokyphosis Sacral slope Max-LL Inflection point |
| url | https://doi.org/10.1186/s12891-022-05379-6 |
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