Residual thoracolumbar/lumbar curve is related to self-image after posterior spinal fusion for Lenke 1 and 2 curves in adolescent idiopathic scoliosis patients

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  • 1 Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto; and
  • 2 Faculty of Textile Science and Technology, Shinshu University, Ueda, Nagano, Japan
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OBJECTIVE

Although it is well known that major curve severity in adolescent idiopathic scoliosis (AIS) is inversely related to self-image, surgeons often encounter patients who complain of low self-image with preoperatively mild curves or postoperatively well-corrected main curves, suggesting the presence of other factors. This study examined factors contributing to self-image in AIS.

METHODS

A total of 86 consecutive patients who underwent posterior spinal fusion for AIS Lenke 1 or 2 curves and were followed for a minimum of 2 years were included in this study of patient self-image based on data that included scores reported on the Scoliosis Research Society survey (SRS-22r). The authors evaluated sex, BMI, Risser grade, age, angle of trunk rotation, Cobb angle of the main thoracic (MT) curve, Cobb angle of the thoracolumbar/lumbar (TL/L) curve, apical vertebral translation (AVT), T5–12 kyphotic angle, and clavicular angle. Univariate and multivariate general linear models were employed to identify preoperative and 2-year postoperative factors that impact self-image.

RESULTS

Univariate analysis revealed no significant correlation between preoperative MT curve Cobb angle and SRS-22r self-image score (p = 0.51), although patients with a higher MT curve AVT had a significantly worse preoperative self-image (p < 0.01). Two years postoperatively, larger Cobb angle of the TL/L curve (p = 0.01) and higher Risser grade (p = 0.03) resulted in significantly lower self-image scores. In multivariate testing, preoperative MT curve AVT remained significantly related to diminished self-image (p < 0.01). Two years later, higher TL/L curve (p < 0.01), Risser grade (p = 0.03), and MT curve AVT (p = 0.03) had significant associations with lower self-image scores.

CONCLUSIONS

Preoperative MT curve AVT appears more strongly related to self-image than does Cobb angle. Two years postoperatively, persistent TL/L region curvature and high Risser grade may also be associated with diminished patient self-image.

ABBREVIATIONS AIS = adolescent idiopathic scoliosis; ATR = angle of trunk rotation; AVT = apical vertebral translation; MT = main thoracic; SRS-22r = Scoliosis Research Society survey; TL/L = thoracolumbar/lumbar.

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Contributor Notes

Correspondence Jun Takahashi: Shinshu University School of Medicine, Matsumoto, Nagano, Japan. jtaka@shinshu-u.ac.jp.

INCLUDE WHEN CITING Published online April 24, 2020; DOI: 10.3171/2020.2.PEDS19656.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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