Postoperative changes in sagittal spinopelvic alignment in sitting position in adolescents with idiopathic thoracic scoliosis treated with posterior fusion: an initial analysis

J Neurosurg Pediatr. 2018 Jul;22(1):74-80. doi: 10.3171/2018.2.PEDS17687. Epub 2018 May 4.


OBJECTIVE Previous studies have reported spinal straightening and pelvic retroversion when changing from erect to sitting posture in patients with adolescent idiopathic scoliosis (AIS), which were thought to be related to low-back pain after sitting for long periods. However, the sitting sagittal alignment after posterior spinal fusion has not been evaluated. This study aims to assess the influence of posterior fusion surgery upon sitting sagittal spinopelvic alignment in adolescents with idiopathic thoracic curves (thoracic AIS [T-AIS]). METHODS A total of 44 T-AIS patients (30 Lenke I and 14 Lenke II) from the authors' center were included in this study. Preoperative and postoperative long-cassette lateral radiographs of the spine and pelvis were obtained with the patients in standing and sitting positions. Thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured on standing and sitting lateral radiographs. Patients were divided into selective thoracic fusion (STF) and nonselective thoracic fusion (NSTF) groups. RESULTS At baseline, TK, LL, and SS decreased by 27.5%, 42.1%, and 31.1%, respectively, from the standing to the sitting position, while PT increased by 193.6%. After posterior spinal fusion, increased TK, LL, and SS and corresponding decreased PT were observed compared to baseline parameters in the sitting position. Comparison of postoperative sitting and standing values for the whole cohort showed that the mean LS and SS values were significantly lower in the sitting position (decreased by 14.0% and 13.9%, respectively, compared to standing), whereas the mean PT value was significantly greater (increased by 39.0%, compared to standing). Similar changes were also observed in the STF group: postoperatively the mean LL value was 15.6% lower in sitting than in standing, while the mean SS value was 11.5% lower. However, no obvious changes of the postoperative values in sitting were found in the NSTF group. CONCLUSIONS Nonselective thoracic fusion surgery in T-AIS patients diminished spinal straightening and pelvic retroversion during sitting. Reducing distal fusion levels was of special value in not only saving more lumbar mobility, but also preserving the function of pelvic posterior rotation.

Keywords: AIS = adolescent idiopathic scoliosis; LIV = lowest instrumented vertebra; LL = lumbar lordosis; NSTF = nonselective thoracic fusion; PI = pelvic incidence; PT = pelvic tilt; SRS-22 = 22-item Scoliosis Research Society questionnaire; SS = sacral slope; STF = selective thoracic fusion; T-AIS = thoracic AIS; TK = thoracic kyphosis; adolescent idiopathic thoracic scoliosis; posterior spinal fusion; sagittal spinopelvic alignment; sitting position; spine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Kyphosis / diagnostic imaging
  • Kyphosis / surgery
  • Lordosis / diagnostic imaging
  • Lordosis / surgery
  • Male
  • Radiography
  • Retrospective Studies
  • Scoliosis / diagnostic imaging
  • Scoliosis / physiopathology*
  • Scoliosis / surgery*
  • Sitting Position*
  • Spinal Fusion / methods*
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / surgery*
  • Treatment Outcome*