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Moving Beyond Radiographs: Changes in Gait Patterns after AIS Realignment
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S113–S250 PURPOSE: The aim of this study is to evaluate the clinical outcome and radiologic parameters affecting magnitude of distal residual curve and spontaneous correction of unfused thoracic curve in Lenke Type 5 adolescent idiopathic scoliosis patients, treated by selective posterior lumbar fusion. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: Thirty-seven Lenke type 5 adolescent idiopathic scoliosis patients. OUTCOME MEASURES: AP, LAT and Ferguson A-rays taken preop and follow-up were used for radiographic evaluation. Clinical outcome was evaluated with SRS-22r questionnaire. METHODS: Thirty-seven (34 female, 3 male) Lenke type 5 adolescent idiopathic scoliosis patients, treated by selective posterior lumbar fusion, were included. Segmental pedicle screw instrumentation with allogenous bone grafting was performed in all levels. Radiographic evaluation involved measurement of coronal and sagittal parameters on preop and follow-up X-rays, as well as measurement of sacral oblique take-off angle. Clinical outcome was evaluated with SRS-22r. Statistical analysis was performed with Spearman’s correlation test. RESULTS: Average age was 15 (12–17) years and follow-up was 61 (24–120) months. Average TL/L Cobb angle improved from 43.7° to 6.9° with 84.2% correction rate. Spontaneous correction rate of unfused thoracic curve was 63%. Average instrumented level was 5.4 (4–7); LIV was L3 in 29 patients and L4 in 8 patients. Average LIV tilt improved from 23.7° to 3.3° (87.6%). Sacral oblique take-off angle was more than 5° (average 7.4° (5–16)) in 27 (72.9%) patients. Lumbar residual angle was more than 10° in 11 patients (40.7%). Disc wedging below LIV was more than 5° in 14 patients (51.9%). There were positive and moderately significant correlations between follow-up lumbar residual angle, disc wedging and sacral oblique take-off angle (r=0,401, p=0,02; r=0,558, p<0,01, respectively). Mean total SRS-22r score improved from 3.8 to 4.25 in follow-up. Pseudarthrosis occurred in one patient (2.85%). There was no infection, neurological deficit, implant failure or unfused thoracic curve progression. CONCLUSIONS: This study demonstrated that selective posterior lumbar fusion (Cobb to Cobb) in Lenke 5 adolescent idiopathic scoliosis patients provide clinical improvement, significant correction of TL/L curve and spontaneous correction of thoracic compensatory curve. If sacral oblique takeoff angle is more than 5°, lumbar residual angle more than 10° and disc wedging below LIV more than 5° are observed, significant correlation between three parameters is found to exist. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
S179
METHODS: AIS patients (pts) underwent gait assessment and full-spine radiographs prior to surgery. Gait analysis was performed in a 6DOF motion analysis laboratory with 100 Hz sampling frequency. Thirty-four reflective markers were placed on each patient, who then underwent straight-line walking trials preop and 2 years postop. Gait parameters, including sagittal and axial marker data, including C7Pelvis motion and offset, pelvic and thoracic motion, were calculated to determine the change in motion from preto postop. AIS patients at pre- and postop were compared to an asymptomatic control cohort. RESULTS: AIS pts (n=15, mean age 14.5y, 73%F, Cobb 57°) were similar to controls in demographics. In the sagittal plane, preop AIS pts had greater anterior C7Pelvis offset (−35 mm vs −51.9) than controls and smaller range of C7Pelvis motion during ambulation (15 vs 20 mm). Preop AIS pts also had abnormal “in-phase” pelvic and thoracic rotation and restricted motion to the right with no counter-rotation points during the gait cycle. Postop, C7 offset of AIS pts translated posteriorly (−49.7 mm, p<.01) and C7Pelvis motion improved by 25% to 20 mm. Postop AIS pts improved in pelvic and thoracic rotation with counter-rotation points occurring at 38% and 65% of the gait cycle, and an increase in maximal thoracic rotation to the right from 0.01 (preop) to 1.60° (postop; p=.034). Cross correlation of the postop AIS sagittal C7Pelvic offset during the whole gait cycle demonstrated a pattern that mirrored the controls (Rxy=0.98; p<.001). CONCLUSIONS: AIS realignment results in improvements in sagittal plane posture, C7Pelvic offsets, axial plane motion, and gait phases that closely resemble normal control patients. However, with increased sagittal and axial motion after long spinal arthrodesis, concern for the remaining unfused segments and disc health arises. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.155
137. The Incidence of Proximal Junctional Kyphosis (PJK) Based on Upper-Instrumented Vertebrae (UIV) in Patients undergoing Circumferential Minimally Invasive Surgical (CMIS) Correction for Adult Spinal Deformity Neel Anand, MD1, Jason Cohen, BS2, Ryan Cohen2, Babak Khandehroo, MD2, Sheila Kahwaty, PA-C3, Eli M. Baron, MD4; 1 Cedars-Sinai Spine Center, Los Angeles, CA, USA; 2Cedars-Sinai Medical Center, Los Angeles, CA, USA; 3Cedars-Sinai Medical Center—Spine Center, Los Angeles, CA, USA; 4Cedars-Sinai Institute for Spinal Disorders, Los Angeles, CA, USA
http://dx.doi.org/10.1016/j.spinee.2016.07.154
136. Moving Beyond Radiographs: Changes in Gait Patterns after AIS Realignment Ashish Patel, MD1, Jeffrey Varghese, BS1, Bassel G. Diebo, MD1, Ayman Assi, PhD2, Ellen Godwin, PT, PhD3, Louis M. Day, BS4, Dan Stein1, Virginie Lafage, PhD1, Carl Paulino, MD5; 1Hospital for Special Surgery, New York, NY, USA; 2Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon; 3Downstate Medical Center, Brooklyn, NY, USA; 4Hospital for Joint Diseases at NYU Langone Medical Center, New York, NY, USA; 5Brooklyn, NY, USA BACKGROUND CONTEXT: Surgical correction for adolescent idiopathic scoliosis (AIS) affords the surgeon to manipulate the spine in all 3 planes. The impact of this correction on gait patterns from pre- to postop is poorly understood. PURPOSE: To investigate if surgical correction improves gait patterns in adolescent idiopathic scoliosis (AIS). STUDY DESIGN/SETTING: Retrospective review of a prospective singlecenter database. PATIENT SAMPLE: Adolescent idiopathic scoliosis patients prior to surgical treatment. OUTCOME MEASURES: Gait parameters.
BACKGROUND CONTEXT: Proximal junctional kyphosis (PJK) is a common complication following spinal surgery. The exact mechanism underlying the radiological phenomenon remains unclear. The purpose of this study was to assess the influence of upper-instrumented vertebra (UIV), baseline deformity and degree of sagittal correction on incidence of PJK in patients undergoing CMIS correction of ASD. PURPOSE: UIV does not influence the incidence of PJK in patients undergoing CMIS correction of ASD. STUDY DESIGN/SETTING: A single center study from a prospective registry of patients who had undergone cMIS correction of ASD (Cobb angle>20° or SVA >50 mm or PI/LL mismatch >10) with minimum 2-year follow-up. PATIENT SAMPLE: Not applicable. OUTCOME MEASURES: Not applicable. METHODS: We identified 121 patients (82 female) with 4+levels fused and 2-year follow-up. All patients were instrumented to the first proximal neutral parallel disc. UIV of the cohort was as follows: 25 at T2-T5, 32 at T10, 24 at T11-T12, 27 at L1 and 13 at L2. PJK was defined as angle greater than 10° and at least 10° greater than the baseline when measuring the lower endplate of the UIV and the upper endplate of 2 vertebra supra-adjacent (UIV+2). The groups were compared in terms of PJK rates using Chisquared analyses (p<.05). Preoperative, latest and delta sagittal vertical alignment (SVA) and pelvic incidence-lumbar lordosis (PI-LL) mismatch were compared between patients with PJK and without.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
S179
METHODS: AIS patients (pts) underwent gait assessment and full-spine radiographs prior to surgery. Gait analysis was performed in a 6DOF motion analysis laboratory with 100 Hz sampling frequency. Thirty-four reflective markers were placed on each patient, who then underwent straight-line walking trials preop and 2 years postop. Gait parameters, including sagittal and axial marker data, including C7Pelvis motion and offset, pelvic and thoracic motion, were calculated to determine the change in motion from preto postop. AIS patients at pre- and postop were compared to an asymptomatic control cohort. RESULTS: AIS pts (n=15, mean age 14.5y, 73%F, Cobb 57°) were similar to controls in demographics. In the sagittal plane, preop AIS pts had greater anterior C7Pelvis offset (−35 mm vs −51.9) than controls and smaller range of C7Pelvis motion during ambulation (15 vs 20 mm). Preop AIS pts also had abnormal “in-phase” pelvic and thoracic rotation and restricted motion to the right with no counter-rotation points during the gait cycle. Postop, C7 offset of AIS pts translated posteriorly (−49.7 mm, p<.01) and C7Pelvis motion improved by 25% to 20 mm. Postop AIS pts improved in pelvic and thoracic rotation with counter-rotation points occurring at 38% and 65% of the gait cycle, and an increase in maximal thoracic rotation to the right from 0.01 (preop) to 1.60° (postop; p=.034). Cross correlation of the postop AIS sagittal C7Pelvic offset during the whole gait cycle demonstrated a pattern that mirrored the controls (Rxy=0.98; p<.001). CONCLUSIONS: AIS realignment results in improvements in sagittal plane posture, C7Pelvic offsets, axial plane motion, and gait phases that closely resemble normal control patients. However, with increased sagittal and axial motion after long spinal arthrodesis, concern for the remaining unfused segments and disc health arises. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.155
137. The Incidence of Proximal Junctional Kyphosis (PJK) Based on Upper-Instrumented Vertebrae (UIV) in Patients undergoing Circumferential Minimally Invasive Surgical (CMIS) Correction for Adult Spinal Deformity Neel Anand, MD1, Jason Cohen, BS2, Ryan Cohen2, Babak Khandehroo, MD2, Sheila Kahwaty, PA-C3, Eli M. Baron, MD4; 1 Cedars-Sinai Spine Center, Los Angeles, CA, USA; 2Cedars-Sinai Medical Center, Los Angeles, CA, USA; 3Cedars-Sinai Medical Center—Spine Center, Los Angeles, CA, USA; 4Cedars-Sinai Institute for Spinal Disorders, Los Angeles, CA, USA
http://dx.doi.org/10.1016/j.spinee.2016.07.154
136. Moving Beyond Radiographs: Changes in Gait Patterns after AIS Realignment Ashish Patel, MD1, Jeffrey Varghese, BS1, Bassel G. Diebo, MD1, Ayman Assi, PhD2, Ellen Godwin, PT, PhD3, Louis M. Day, BS4, Dan Stein1, Virginie Lafage, PhD1, Carl Paulino, MD5; 1Hospital for Special Surgery, New York, NY, USA; 2Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon; 3Downstate Medical Center, Brooklyn, NY, USA; 4Hospital for Joint Diseases at NYU Langone Medical Center, New York, NY, USA; 5Brooklyn, NY, USA BACKGROUND CONTEXT: Surgical correction for adolescent idiopathic scoliosis (AIS) affords the surgeon to manipulate the spine in all 3 planes. The impact of this correction on gait patterns from pre- to postop is poorly understood. PURPOSE: To investigate if surgical correction improves gait patterns in adolescent idiopathic scoliosis (AIS). STUDY DESIGN/SETTING: Retrospective review of a prospective singlecenter database. PATIENT SAMPLE: Adolescent idiopathic scoliosis patients prior to surgical treatment. OUTCOME MEASURES: Gait parameters.
BACKGROUND CONTEXT: Proximal junctional kyphosis (PJK) is a common complication following spinal surgery. The exact mechanism underlying the radiological phenomenon remains unclear. The purpose of this study was to assess the influence of upper-instrumented vertebra (UIV), baseline deformity and degree of sagittal correction on incidence of PJK in patients undergoing CMIS correction of ASD. PURPOSE: UIV does not influence the incidence of PJK in patients undergoing CMIS correction of ASD. STUDY DESIGN/SETTING: A single center study from a prospective registry of patients who had undergone cMIS correction of ASD (Cobb angle>20° or SVA >50 mm or PI/LL mismatch >10) with minimum 2-year follow-up. PATIENT SAMPLE: Not applicable. OUTCOME MEASURES: Not applicable. METHODS: We identified 121 patients (82 female) with 4+levels fused and 2-year follow-up. All patients were instrumented to the first proximal neutral parallel disc. UIV of the cohort was as follows: 25 at T2-T5, 32 at T10, 24 at T11-T12, 27 at L1 and 13 at L2. PJK was defined as angle greater than 10° and at least 10° greater than the baseline when measuring the lower endplate of the UIV and the upper endplate of 2 vertebra supra-adjacent (UIV+2). The groups were compared in terms of PJK rates using Chisquared analyses (p<.05). Preoperative, latest and delta sagittal vertical alignment (SVA) and pelvic incidence-lumbar lordosis (PI-LL) mismatch were compared between patients with PJK and without.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.