Cervical sagittal balance after AIS instrumentation
Keywords:
Scoliosis, cervical sagittal balance, spinal instrumentation
Abstract
Cervical sagittal balance is one of the trending topics in the literatures. More than 60 articles were published on this hot topic. The harmonious relationship between spinal curves and kyphotic deterioration proximal to instrumentation made the researchers’ main intentions. Most authors investigate the changes in cervical sagittal curves after AIS instrumentation and look for any correlation between the sagittal parameter that could hint at potential changes after instrumentation. Some authors look into the upper instrumentation level effect on cervical alignment others searched for coronal plane deformities effect on the sagittal plane. Prospective studies will be more convincing since retrospective studies show the opposite results. A meta-analysis of future prospective studies will clarify the confusion on upper instrumentation level effect on CSB, implant choice of instrumentation, PJK reasons, correlation with global spine balance, and finally, relationship with whole-body alignment. Correction of thoracic hypokyposis, especially proximal thoracic, could stimulate cervical lordotic changes over time. Flattening of the entire spine either by surgery or bracing ends up with cervical kyphosis. In this updated historical review of cervical sagittal balance after AIS instrumentation, we want to report the most current and organized knowledge of this exciting area of the spine studies. To make it more systematic, we subdivide primary theme into six main sections to answer all the potential questions of the readers. While giving essential information about cervical sagittal balance, we also delve into details to clarify this very confusing area.
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References
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2. Le Huec JC, Thompson W, Mohsinaly Y, et al. Sagittal balance of the spine. Eur Spine J. 2019;28(9):1889-1905.
3. Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2012;71(3):662-669; discussion 669.
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5. Fan Y, Wang J, Cai M, et al. The Correlation Between Postoperative Cervical Sagittal Alignment and Spine Sagittal Alignment in Adolescent Idiopathic Scoliosis: A Meta-Analysis. World Neurosurg. 2020;134:e311-e316.
6. Abelin-Genevois K, Sassi D, Verdun S, et al. Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications. Eur Spine J. 2018;27(9):2192-2202.
7. Smith JS, Shaffrey CI, Lafage V, et al. Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. J Neurosurg Spine. 2012;17(4):300-307.
8. Wang L, Liu X. Cervical sagittal alignment in adolescent idiopathic scoliosis patients (Lenke type 1–6). J Orthop Sci. 2017;22(2):254-259.
9. Moreira Pinto E, Alves J, de Castro AM, et al. High thoracic kyphosis: impact on total thoracic kyphosis and cervical alignment in patients with adolescent idiopathic scoliosis. Spine deformity. 2020;8(4):647-653.
10. Akbar M, Almansour H, Lafage R, et al. Sagittal alignment of the cervical spine in the setting of adolescent idiopathic scoliosis. J Neurosurg Spine. 2018;29(5):506-514.
11. Pepke W, Almansour H, Lafage R, et al. Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients. BMC Surg. 2019;19(1):7.
12. Ito K, Imagama S, Ito Z, et al. Analysis of cervical kyphosis and spinal balance in young idiopathic scoliosis patients classified by the apex of thoracic kyphosis. Eur Spine J. 2016;25(10):3220-3225.
13. Hilibrand AS. The Sagittal Alignment of the Cervical Spine in Adolescent Idiopathic Scoliosis. In:1995:627-632.
14. Persson PR, Hirschfeld H, Nilsson-Wikmar L. Associated sagittal spinal movements in performance of head pro- and retraction in healthy women: a kinematic analysis. Man Ther. 2007;12(2):119-125.
15. Canavese F, Turcot K, De Rosa V, et al. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J. 2011;20(7):1141-1148.
16. Shimizu T, Cerpa M, Lehman RA, et al. Reciprocal Change in Sagittal Profiles After Adolescent Idiopathic Scoliosis Surgery With Segmental Pedicle Screw Construct: A Full-body X-ray Analysis. Spine (Phila Pa 1976). 2019;44(24):1705-1714.
17. Zhang Z, Ma X, Yin J, et al. Alterations of sagittal alignment and thoracic cage parameters after long-term bracing in adolescents with idiopathic scoliosis. Orthop Traumatol Surg Res. 2020.
18. Ketenci IE, Yanik HS, Erdem S. The effect of upper instrumented vertebra level on cervical sagittal alignment in Lenke 1 adolescent idiopathic scoliosis. Orthop Traumatol Surg Res. 2018;104(5):623-629.
19. Zhao J, Chen Z, Yang M, et al. Does spinal fusion to T2, T3, or T4 affects sagittal alignment of the cervical spine in Lenke 1 AIS patients: A retrospective study. Medicine (Baltimore). 2018;97(5):e9764.
20. Legarreta CA, Barrios C, Rositto GE, et al. Cervical and thoracic sagittal misalignment after surgery for adolescent idiopathic scoliosis: a comparative study of all pedicle screws versus hybrid instrumentation. Spine (Phila Pa 1976). 2014;39(16):1330-1337.
21. Yanik HS, Ketenci IE, Erdem S. Cervical Sagittal Alignment in Extensive Fusions for Lenke 3C and 6C Scoliosis: The Effect of Upper Instrumented Vertebra. Spine (Phila Pa 1976). 2017;42(6):E355-e362.
22. Ramírez-Villaescusa J, Cambronero Honrubia I, Ruiz-Picazo D, et al. Thoracic pedicle subtraction osteotomy for correction of proximal junctional kyphosis after surgery for adolescent idiopathic scoliosis: A case report. Int J Surg Case Rep. 2020;67:66-70.
23. Sun Z, Qiu G, Zhao Y, et al. Risk factors of proximal junctional angle increase after selective posterior thoracolumbar/lumbar fusion in patients with adolescent idiopathic scoliosis. Eur Spine J. 2015;24(2):290-297.
24. Homans JF, Kruyt MC, Schlösser TPC, et al. Changes in the Position of the Junctional Vertebrae After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: Implication in Risk Assessment of Proximal Junctional Kyphosis Development. J Pediatr Orthop. 2020;40(2):e84-e90.
25. Ferrero E, Bocahut N, Lefevre Y, et al. Proximal junctional kyphosis in thoracic adolescent idiopathic scoliosis: risk factors and compensatory mechanisms in a multicenter national cohort. Eur Spine J. 2018;27(9):2241-2250.
26. Ghailane S, Pesenti S, Peltier E, et al. Posterior elements disruption with hybrid constructs in AIS patients: is there an impact on proximal junctional kyphosis? Arch Orthop Trauma Surg. 2017;137(5):631-635.
27. Legarreta CA, Barrios C, Rositto GE, et al. Cervical and Thoracic Sagittal Misalignment After Surgery for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2014;39(16):1330-1337.
28. Ilharreborde B, Vidal C, Skalli W, et al. Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation. Eur Spine J. 2013;22(2):330-337.
29. Dumpa SR, Shetty AP, Aiyer SN, et al. Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation. Asian spine journal. 2018;12(2):300-308.
30. Charles YP, Sfeir G, Matter-Parrat V, et al. Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. Spine (Phila Pa 1976). 2015;40(7):E419-427.
31. Berger RJ, Sultan AA, Tanenbaum JE, et al. Cervical sagittal alignment and the impact of posterior spinal instrumented fusion in patients with Lenke type 1 adolescent idiopathic scoliosis. Journal of spine surgery (Hong Kong). 2018;4(2):342-348.
32. Miyazaki M, Ishihara T, Abe T, et al. Analysis of reciprocal changes in upper cervical profiles after posterior spinal fusion with the simultaneous double rod rotation technique for adolescent idiopathic scoliosis. Orthop Traumatol Surg Res. 2020.
33. Tauchi R, Kawakami N, Ohara T, et al. Sagittal Alignment Profile Following Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke Type 5C Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2019;44(17):1193-1200.
34. Yan P, Zhang Y, Liu S, et al. Sagittal Profile Response of Cervical Spine After Posterior Correction in Thoracic and Lumbar Adolescent Idiopathic Scoliosis: Correlation with Thoracic Kyphosis? World Neurosurg. 2018;120:e333-e341.
35. Tang Y, Xu X, Zhu F, et al. Incidence and Risk Factors of Cervical Kyphosis in Patients with Adolescent Idiopathic Scoliosis. World Neurosurg. 2019;127:e788-e792.
36. Hu X, Lieberman IH. Prevalence and Factors Affecting Cervical Deformity in Adolescent Idiopathic Scoliosis Patients: A Single-Center Retrospective Radiological Study. International journal of spine surgery. 2018;12(1):22-25.
37. Cho JH, Hwang CJ, Choi YH, et al. Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery? J Neurosurg Pediatr. 2018;21(3):292-301.
2. Le Huec JC, Thompson W, Mohsinaly Y, et al. Sagittal balance of the spine. Eur Spine J. 2019;28(9):1889-1905.
3. Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2012;71(3):662-669; discussion 669.
4. Bao H, Varghese J, Lafage R, et al. Principal Radiographic Characteristics for Cervical Spinal Deformity: A Health-related Quality-of-life Analysis. Spine (Phila Pa 1976). 2017;42(18):1375-1382.
5. Fan Y, Wang J, Cai M, et al. The Correlation Between Postoperative Cervical Sagittal Alignment and Spine Sagittal Alignment in Adolescent Idiopathic Scoliosis: A Meta-Analysis. World Neurosurg. 2020;134:e311-e316.
6. Abelin-Genevois K, Sassi D, Verdun S, et al. Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications. Eur Spine J. 2018;27(9):2192-2202.
7. Smith JS, Shaffrey CI, Lafage V, et al. Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. J Neurosurg Spine. 2012;17(4):300-307.
8. Wang L, Liu X. Cervical sagittal alignment in adolescent idiopathic scoliosis patients (Lenke type 1–6). J Orthop Sci. 2017;22(2):254-259.
9. Moreira Pinto E, Alves J, de Castro AM, et al. High thoracic kyphosis: impact on total thoracic kyphosis and cervical alignment in patients with adolescent idiopathic scoliosis. Spine deformity. 2020;8(4):647-653.
10. Akbar M, Almansour H, Lafage R, et al. Sagittal alignment of the cervical spine in the setting of adolescent idiopathic scoliosis. J Neurosurg Spine. 2018;29(5):506-514.
11. Pepke W, Almansour H, Lafage R, et al. Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients. BMC Surg. 2019;19(1):7.
12. Ito K, Imagama S, Ito Z, et al. Analysis of cervical kyphosis and spinal balance in young idiopathic scoliosis patients classified by the apex of thoracic kyphosis. Eur Spine J. 2016;25(10):3220-3225.
13. Hilibrand AS. The Sagittal Alignment of the Cervical Spine in Adolescent Idiopathic Scoliosis. In:1995:627-632.
14. Persson PR, Hirschfeld H, Nilsson-Wikmar L. Associated sagittal spinal movements in performance of head pro- and retraction in healthy women: a kinematic analysis. Man Ther. 2007;12(2):119-125.
15. Canavese F, Turcot K, De Rosa V, et al. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J. 2011;20(7):1141-1148.
16. Shimizu T, Cerpa M, Lehman RA, et al. Reciprocal Change in Sagittal Profiles After Adolescent Idiopathic Scoliosis Surgery With Segmental Pedicle Screw Construct: A Full-body X-ray Analysis. Spine (Phila Pa 1976). 2019;44(24):1705-1714.
17. Zhang Z, Ma X, Yin J, et al. Alterations of sagittal alignment and thoracic cage parameters after long-term bracing in adolescents with idiopathic scoliosis. Orthop Traumatol Surg Res. 2020.
18. Ketenci IE, Yanik HS, Erdem S. The effect of upper instrumented vertebra level on cervical sagittal alignment in Lenke 1 adolescent idiopathic scoliosis. Orthop Traumatol Surg Res. 2018;104(5):623-629.
19. Zhao J, Chen Z, Yang M, et al. Does spinal fusion to T2, T3, or T4 affects sagittal alignment of the cervical spine in Lenke 1 AIS patients: A retrospective study. Medicine (Baltimore). 2018;97(5):e9764.
20. Legarreta CA, Barrios C, Rositto GE, et al. Cervical and thoracic sagittal misalignment after surgery for adolescent idiopathic scoliosis: a comparative study of all pedicle screws versus hybrid instrumentation. Spine (Phila Pa 1976). 2014;39(16):1330-1337.
21. Yanik HS, Ketenci IE, Erdem S. Cervical Sagittal Alignment in Extensive Fusions for Lenke 3C and 6C Scoliosis: The Effect of Upper Instrumented Vertebra. Spine (Phila Pa 1976). 2017;42(6):E355-e362.
22. Ramírez-Villaescusa J, Cambronero Honrubia I, Ruiz-Picazo D, et al. Thoracic pedicle subtraction osteotomy for correction of proximal junctional kyphosis after surgery for adolescent idiopathic scoliosis: A case report. Int J Surg Case Rep. 2020;67:66-70.
23. Sun Z, Qiu G, Zhao Y, et al. Risk factors of proximal junctional angle increase after selective posterior thoracolumbar/lumbar fusion in patients with adolescent idiopathic scoliosis. Eur Spine J. 2015;24(2):290-297.
24. Homans JF, Kruyt MC, Schlösser TPC, et al. Changes in the Position of the Junctional Vertebrae After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: Implication in Risk Assessment of Proximal Junctional Kyphosis Development. J Pediatr Orthop. 2020;40(2):e84-e90.
25. Ferrero E, Bocahut N, Lefevre Y, et al. Proximal junctional kyphosis in thoracic adolescent idiopathic scoliosis: risk factors and compensatory mechanisms in a multicenter national cohort. Eur Spine J. 2018;27(9):2241-2250.
26. Ghailane S, Pesenti S, Peltier E, et al. Posterior elements disruption with hybrid constructs in AIS patients: is there an impact on proximal junctional kyphosis? Arch Orthop Trauma Surg. 2017;137(5):631-635.
27. Legarreta CA, Barrios C, Rositto GE, et al. Cervical and Thoracic Sagittal Misalignment After Surgery for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2014;39(16):1330-1337.
28. Ilharreborde B, Vidal C, Skalli W, et al. Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation. Eur Spine J. 2013;22(2):330-337.
29. Dumpa SR, Shetty AP, Aiyer SN, et al. Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation. Asian spine journal. 2018;12(2):300-308.
30. Charles YP, Sfeir G, Matter-Parrat V, et al. Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. Spine (Phila Pa 1976). 2015;40(7):E419-427.
31. Berger RJ, Sultan AA, Tanenbaum JE, et al. Cervical sagittal alignment and the impact of posterior spinal instrumented fusion in patients with Lenke type 1 adolescent idiopathic scoliosis. Journal of spine surgery (Hong Kong). 2018;4(2):342-348.
32. Miyazaki M, Ishihara T, Abe T, et al. Analysis of reciprocal changes in upper cervical profiles after posterior spinal fusion with the simultaneous double rod rotation technique for adolescent idiopathic scoliosis. Orthop Traumatol Surg Res. 2020.
33. Tauchi R, Kawakami N, Ohara T, et al. Sagittal Alignment Profile Following Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke Type 5C Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2019;44(17):1193-1200.
34. Yan P, Zhang Y, Liu S, et al. Sagittal Profile Response of Cervical Spine After Posterior Correction in Thoracic and Lumbar Adolescent Idiopathic Scoliosis: Correlation with Thoracic Kyphosis? World Neurosurg. 2018;120:e333-e341.
35. Tang Y, Xu X, Zhu F, et al. Incidence and Risk Factors of Cervical Kyphosis in Patients with Adolescent Idiopathic Scoliosis. World Neurosurg. 2019;127:e788-e792.
36. Hu X, Lieberman IH. Prevalence and Factors Affecting Cervical Deformity in Adolescent Idiopathic Scoliosis Patients: A Single-Center Retrospective Radiological Study. International journal of spine surgery. 2018;12(1):22-25.
37. Cho JH, Hwang CJ, Choi YH, et al. Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery? J Neurosurg Pediatr. 2018;21(3):292-301.
Published
2021-04-26
Section
Review
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