The thoracic lordosis correction improves sacral slope and walking ability in neuromuscular scoliosis

Do Yeon Kim, Eun Su Moon, Jin Oh Park, Hyon Su Chong, Hwan Mo Lee, seonghwan moon, Sung Hoon Kim, Hak Sun Kim

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study Design: Retrospective study. Objective: To report on neuromuscular patients with preserved walking ability, but forward bending of the body due to thoracic lordosis, and to suggest thoracic lordosis correction as the surgical treatment. Summary of Background Data: It is an established fact that lumbar lordosis or pelvic parameter is directly related to thoracic sagittal balance. However, the reverse relationship has not been fully defined yet. Loss of thoracic kyphosis results in positive sagittal balance, which causes walking difficulty. Neuromuscular patients with thoracic lordosis have not been reported yet, and there have been no reports on their surgical treatments. Methods: This study analyzed 8 patients treated with thoracic lordosis correction surgery. Every patient was diagnosed with muscular dystrophy. In thoracic lordosis correction surgery, anterior release was performed in the first stage and posterior segmental instrumentation was performed in the second stage. Radiographic parameters were compared and walking ability was evaluated with gait analysis. All patients were classified according to the modified Rancho Los Amigos Hospital system preoperatively and 2 years postoperatively to evaluate functional ability. The average follow-up period was 2.9 years. Results: Before surgery, the mean thoracic sagittal alignment was -2.1-degree lordosis, the mean Cobb angle and sacral slope increased to 36.3 and 56.6 degrees, respectively. The anterior pelvic tilt in gait analysis was 29.3 degrees. At last follow-up after surgery, the mean thoracic sagittal alignment changed to 12.6-degree kyphosis, and the Cobb angle and sacral slope decreased to 18.9 and 39.5 degrees, respectively. Lumbar lordosis and the sacral slope showed significant positive correlation (P<0.001). The improvement in thoracic lordosis showed a significant correlation to the preoperative flexibility of the major curve (P=0.028). The anterior pelvic tilt in gait analysis improved to 15.4 degrees. The functional ability improved in 2 (50%) of 4 patients in class 2 and maintained in remaining 6 patients 2 years after surgery. Conclusions: Thoracic lordosis correction surgery in neuromuscular scoliosis patients with thoracic lordosis improved the sacral slope in the standing position and the anterior pelvic tilt in gait. Sagittal imbalance was compensated by the spinopelvic mechanism, and back and hip extensor muscles seem to play a major role in this compensation.

Original languageEnglish
Pages (from-to)E413-E420
JournalClinical Spine Surgery
Volume29
Issue number8
DOIs
Publication statusPublished - 2016 Oct 1

Fingerprint

Lordosis
Scoliosis
Walking
Thorax
Gait
Kyphosis
Thoracic Surgery
Mobility Limitation
Muscular Dystrophies
Posture
Hip
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Kim, Do Yeon ; Moon, Eun Su ; Park, Jin Oh ; Chong, Hyon Su ; Lee, Hwan Mo ; moon, seonghwan ; Kim, Sung Hoon ; Kim, Hak Sun. / The thoracic lordosis correction improves sacral slope and walking ability in neuromuscular scoliosis. In: Clinical Spine Surgery. 2016 ; Vol. 29, No. 8. pp. E413-E420.
@article{764a63109113486aaffa65a30ad9d99c,
title = "The thoracic lordosis correction improves sacral slope and walking ability in neuromuscular scoliosis",
abstract = "Study Design: Retrospective study. Objective: To report on neuromuscular patients with preserved walking ability, but forward bending of the body due to thoracic lordosis, and to suggest thoracic lordosis correction as the surgical treatment. Summary of Background Data: It is an established fact that lumbar lordosis or pelvic parameter is directly related to thoracic sagittal balance. However, the reverse relationship has not been fully defined yet. Loss of thoracic kyphosis results in positive sagittal balance, which causes walking difficulty. Neuromuscular patients with thoracic lordosis have not been reported yet, and there have been no reports on their surgical treatments. Methods: This study analyzed 8 patients treated with thoracic lordosis correction surgery. Every patient was diagnosed with muscular dystrophy. In thoracic lordosis correction surgery, anterior release was performed in the first stage and posterior segmental instrumentation was performed in the second stage. Radiographic parameters were compared and walking ability was evaluated with gait analysis. All patients were classified according to the modified Rancho Los Amigos Hospital system preoperatively and 2 years postoperatively to evaluate functional ability. The average follow-up period was 2.9 years. Results: Before surgery, the mean thoracic sagittal alignment was -2.1-degree lordosis, the mean Cobb angle and sacral slope increased to 36.3 and 56.6 degrees, respectively. The anterior pelvic tilt in gait analysis was 29.3 degrees. At last follow-up after surgery, the mean thoracic sagittal alignment changed to 12.6-degree kyphosis, and the Cobb angle and sacral slope decreased to 18.9 and 39.5 degrees, respectively. Lumbar lordosis and the sacral slope showed significant positive correlation (P<0.001). The improvement in thoracic lordosis showed a significant correlation to the preoperative flexibility of the major curve (P=0.028). The anterior pelvic tilt in gait analysis improved to 15.4 degrees. The functional ability improved in 2 (50{\%}) of 4 patients in class 2 and maintained in remaining 6 patients 2 years after surgery. Conclusions: Thoracic lordosis correction surgery in neuromuscular scoliosis patients with thoracic lordosis improved the sacral slope in the standing position and the anterior pelvic tilt in gait. Sagittal imbalance was compensated by the spinopelvic mechanism, and back and hip extensor muscles seem to play a major role in this compensation.",
author = "Kim, {Do Yeon} and Moon, {Eun Su} and Park, {Jin Oh} and Chong, {Hyon Su} and Lee, {Hwan Mo} and seonghwan moon and Kim, {Sung Hoon} and Kim, {Hak Sun}",
year = "2016",
month = "10",
day = "1",
doi = "10.1097/BSD.0b013e318294368e",
language = "English",
volume = "29",
pages = "E413--E420",
journal = "Clinical Spine Surgery",
issn = "2380-0186",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

The thoracic lordosis correction improves sacral slope and walking ability in neuromuscular scoliosis. / Kim, Do Yeon; Moon, Eun Su; Park, Jin Oh; Chong, Hyon Su; Lee, Hwan Mo; moon, seonghwan; Kim, Sung Hoon; Kim, Hak Sun.

In: Clinical Spine Surgery, Vol. 29, No. 8, 01.10.2016, p. E413-E420.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The thoracic lordosis correction improves sacral slope and walking ability in neuromuscular scoliosis

AU - Kim, Do Yeon

AU - Moon, Eun Su

AU - Park, Jin Oh

AU - Chong, Hyon Su

AU - Lee, Hwan Mo

AU - moon, seonghwan

AU - Kim, Sung Hoon

AU - Kim, Hak Sun

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Study Design: Retrospective study. Objective: To report on neuromuscular patients with preserved walking ability, but forward bending of the body due to thoracic lordosis, and to suggest thoracic lordosis correction as the surgical treatment. Summary of Background Data: It is an established fact that lumbar lordosis or pelvic parameter is directly related to thoracic sagittal balance. However, the reverse relationship has not been fully defined yet. Loss of thoracic kyphosis results in positive sagittal balance, which causes walking difficulty. Neuromuscular patients with thoracic lordosis have not been reported yet, and there have been no reports on their surgical treatments. Methods: This study analyzed 8 patients treated with thoracic lordosis correction surgery. Every patient was diagnosed with muscular dystrophy. In thoracic lordosis correction surgery, anterior release was performed in the first stage and posterior segmental instrumentation was performed in the second stage. Radiographic parameters were compared and walking ability was evaluated with gait analysis. All patients were classified according to the modified Rancho Los Amigos Hospital system preoperatively and 2 years postoperatively to evaluate functional ability. The average follow-up period was 2.9 years. Results: Before surgery, the mean thoracic sagittal alignment was -2.1-degree lordosis, the mean Cobb angle and sacral slope increased to 36.3 and 56.6 degrees, respectively. The anterior pelvic tilt in gait analysis was 29.3 degrees. At last follow-up after surgery, the mean thoracic sagittal alignment changed to 12.6-degree kyphosis, and the Cobb angle and sacral slope decreased to 18.9 and 39.5 degrees, respectively. Lumbar lordosis and the sacral slope showed significant positive correlation (P<0.001). The improvement in thoracic lordosis showed a significant correlation to the preoperative flexibility of the major curve (P=0.028). The anterior pelvic tilt in gait analysis improved to 15.4 degrees. The functional ability improved in 2 (50%) of 4 patients in class 2 and maintained in remaining 6 patients 2 years after surgery. Conclusions: Thoracic lordosis correction surgery in neuromuscular scoliosis patients with thoracic lordosis improved the sacral slope in the standing position and the anterior pelvic tilt in gait. Sagittal imbalance was compensated by the spinopelvic mechanism, and back and hip extensor muscles seem to play a major role in this compensation.

AB - Study Design: Retrospective study. Objective: To report on neuromuscular patients with preserved walking ability, but forward bending of the body due to thoracic lordosis, and to suggest thoracic lordosis correction as the surgical treatment. Summary of Background Data: It is an established fact that lumbar lordosis or pelvic parameter is directly related to thoracic sagittal balance. However, the reverse relationship has not been fully defined yet. Loss of thoracic kyphosis results in positive sagittal balance, which causes walking difficulty. Neuromuscular patients with thoracic lordosis have not been reported yet, and there have been no reports on their surgical treatments. Methods: This study analyzed 8 patients treated with thoracic lordosis correction surgery. Every patient was diagnosed with muscular dystrophy. In thoracic lordosis correction surgery, anterior release was performed in the first stage and posterior segmental instrumentation was performed in the second stage. Radiographic parameters were compared and walking ability was evaluated with gait analysis. All patients were classified according to the modified Rancho Los Amigos Hospital system preoperatively and 2 years postoperatively to evaluate functional ability. The average follow-up period was 2.9 years. Results: Before surgery, the mean thoracic sagittal alignment was -2.1-degree lordosis, the mean Cobb angle and sacral slope increased to 36.3 and 56.6 degrees, respectively. The anterior pelvic tilt in gait analysis was 29.3 degrees. At last follow-up after surgery, the mean thoracic sagittal alignment changed to 12.6-degree kyphosis, and the Cobb angle and sacral slope decreased to 18.9 and 39.5 degrees, respectively. Lumbar lordosis and the sacral slope showed significant positive correlation (P<0.001). The improvement in thoracic lordosis showed a significant correlation to the preoperative flexibility of the major curve (P=0.028). The anterior pelvic tilt in gait analysis improved to 15.4 degrees. The functional ability improved in 2 (50%) of 4 patients in class 2 and maintained in remaining 6 patients 2 years after surgery. Conclusions: Thoracic lordosis correction surgery in neuromuscular scoliosis patients with thoracic lordosis improved the sacral slope in the standing position and the anterior pelvic tilt in gait. Sagittal imbalance was compensated by the spinopelvic mechanism, and back and hip extensor muscles seem to play a major role in this compensation.

UR - http://www.scopus.com/inward/record.url?scp=84992153362&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992153362&partnerID=8YFLogxK

U2 - 10.1097/BSD.0b013e318294368e

DO - 10.1097/BSD.0b013e318294368e

M3 - Article

VL - 29

SP - E413-E420

JO - Clinical Spine Surgery

JF - Clinical Spine Surgery

SN - 2380-0186

IS - 8

ER -