This study aimed to investigate the relationship between pelvic incidence and sagittal spinal morphology in Lenke 5 adolescent idiopathic scoliosis (AIS) and its impact on the proximal junctional kyphosis rate after surgery.
The study enrolled a total of 52 cases of Lenke 5 AIS between September 2009 and December 2018. Sagittal spinal morphological parameters, pelvic incidence (PI) and the proximal junctional angle were measured on full-length spinal standing lateral x-ray films preoperatively, postoperatively and at the final follow-up. Pearson correlation analysis was performed to reveal the relationship between sagittal spinal morphology and PI. Multivariable regression analysis and receiver operating characteristic (ROC) curve analysis were performed to identify the risk factors for proximal junctional kyphosis (PJK).
A correlation was found between PI and sagittal spinal morphological parameters, but not between PI and lumbar lordosis. The PJK rate after surgery was 23% (12/52). PI was revealed as an independent risk factor for proximal junctional kyphosis according to multivariable regression analysis (OR = 0.902, p = 0.049). Both multivariable regression analysis and ROC curve analysis verified that restoring a rational postoperative PI-LL/PLL relationship reduced the rate of PJK, including PI-LL mismatch (OR = 0.743, p = 0.046; cutoff value = − 15.5°), the LL-PI ratio (OR = 5.756, p = 0.021; cutoff value = 1.09), and the PLL-PI ratio (OR = 2.116, p = 0.016; cutoff value = 0.40).
PI influences sagittal spinal morphology in Lenke 5 AIS, although it does not show an inherent relationship with lumbar lordosis. PI also correlates to the PJK rate after surgery. Restoring an ideal postoperative PI-LL relationship could decrease the PJK rate.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Ozkunt O, Karademir G, Sariyilmaz K, Gemalmaz HC, Dikici F, Domanic U (2017) Analysing the change of sagittal balance in patients with Lenke 5 idiopathic scoliosis. Acta Orthop Traumato 51:377–380. https://doi.org/10.1016/j.aott.2017.08.002
Upasani VV, Tis J, Bastrom T, Pawelek J, Marks M, Lonner B, Crawford A, Newton PO (2007) Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis: how do these two curve types differ? Spine (Phila Pa 1976) 32:1355–1359. https://doi.org/10.1097/BRS.0b013e318059321d
Mac-Thiong J, Berthonnaud É, Dimar JR, Betz RR, Labelle H (2004) Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976) 29:1642–1647. https://doi.org/10.1097/01.brs.0000132312.78469.7b
Rajnics P, Templier A, Skalli W, Lavaste F, Illes T (2002) The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech 15:24–30. https://doi.org/10.1097/00024720-200202000-00004
Kim YJ, Bridwell KH, Lenke LG, Kim J, Cho SK (2005) Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine (Phila Pa 1976) 30:2045–2050. https://doi.org/10.1097/01.brs.0000179084.45839.ad
Smith JS, Shaffrey CI, Klineberg E, Lafage V, Schwab F, Lafage R, Kim HJ, Hostin R, Mundis GM, Gupta M (2017) Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up. J Neurosurgery Spin. https://doi.org/10.3171/2016.10.SPINE16849
Zhao J, Yang M, Yang Y, Chen Z, Li M (2018) Proximal junctional kyphosis following correction surgery in the Lenke 5 adolescent idiopathic scoliosis patient. J Orthop Sci 23:744–749. https://doi.org/10.1016/j.jos.2018.05.010
Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surgery Am 83:1169–1181. https://doi.org/10.2106/00004623-200108000-00006
Lenke LG, Betz RR, Haher TR, Lapp MA, Merola AA, Harms J, Shufflebarger HL (2001) Multisurgeon assessment of surgical decision-making in adolescent idiopathic scoliosis: curve classification, operative approach, and fusion levels. Spine (Phila Pa 1976) 26:2347–2353. https://doi.org/10.1097/00007632-200111010-00011
Chen X, Chen Z, Qiu Y, Zhu Z, Li S, Xu L, Sun X (2017) Proximal junctional kyphosis after posterior spinal instrumentation and fusion in young children with congenital scoliosis: a preliminary report on its incidence and risk factors. Spine 42:E1197. https://doi.org/10.1097/BRS.0000000000002109
Chen X, Xu L, Qiu Y, Chen Z, Zhu Z, Li S, Sun X (2018) Incidence, risk factors, and evolution of proximal junctional kyphosis after posterior Hemivertebra resection and short fusion in young children with congenital scoliosis. Spine 43:1193–1200. https://doi.org/10.1097/BRS.0000000000002593
Ohrt-Nissen S, Bari T, Dahl B, Gehrchen M (2018) Sagittal alignment after surgical treatment of adolescent idiopathic scoliosis—application of the roussouly classification. Spine Deformity 6:537–544. https://doi.org/10.1016/j.jspd.2018.02.001
Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20:609–618. https://doi.org/10.1007/s00586-011-1928-x
Pesenti S, Lafage R, Stein D, Elysee JC, Lenke LG, Schwab FJ, Kim HJ, Lafage V (2018) The amount of proximal lumbar lordosis is related to pelvic incidence. Clin Orthop Relat Res 476:1603–1611. https://doi.org/10.1097/CORR.0000000000000380
Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353. https://doi.org/10.1097/01.brs.0000152379.54463.65
Pan C, Wang G, Sun J (2020) Correlation between the apex of lumbar lordosis and pelvic incidence in asymptomatic adult. Eur Spine J 29:420–427. https://doi.org/10.1007/s00586-019-06183-y
Sullivan TB, Marino N, Reighard FG, Newton PO (2018) Relationship between lumbar lordosis and pelvic incidence in the adolescent patient: normal cohort analysis and literature comparison. Spine Deform 6:529–536. https://doi.org/10.1016/j.jspd.2018.02.002
Tono O, Hasegawa K, Okamoto M, Hatsushikano S, Shimoda H, Watanabe K, Harimaya K (2019) Lumbar lordosis does not correlate with pelvic incidence in the cases with the lordosis apex located at L3 or above. Eur Spine J 28:1948–1954. https://doi.org/10.1007/s00586-018-5695-9
Laouissat F, Sebaaly A, Gehrchen M, Roussouly P (2018) Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 27:2002–2011. https://doi.org/10.1007/s00586-017-5111-x
Lonner BS, Ren Y, Newton PO, Shah SA, Samdani AF, Shufflebarger HL, Asghar J, Sponseller P, Betz RR, Yaszay B (2017) Risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis—the pelvis and other considerations. Spine Deformity 5:181–188. https://doi.org/10.1016/j.jspd.2016.10.003
Hollenbeck SM, Glattes RC, Asher MA, Lai SM, Burton DC (2008) The prevalence of increased proximal junctional flexion following posterior instrumentation and arthrodesis for adolescent idiopathic scoliosis. Spine (Philadelphia, Pa. 1976) 33:1675–1681. https://doi.org/10.1097/BRS.0b013e31817b5bea
Ogura Y, Glassman SD, Sucato D, Hresko MT, Carreon LY (2020) Incidence of proximal junctional kyphosis with pedicle screws at upper instrumented vertebrae in posterior spinal fusion for adolescent idiopathic scoliosis. Global Spine J. https://doi.org/10.1177/2192568220935107
Sebaaly A, Gehrchen M, Silvestre C, Kharrat K, Roussouly P (2019) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J. https://doi.org/10.1007/s00586-019-06253-1
The study does not receive funding from any organization.
Conflict of interest
The authors declare that they have no conflict of interest.
Permission to conduct this retrospective study was obtained from the authors’ hospital ethics committee.
Consent to participate
All the patients included consent to participate in the retrospective study.
Consent for publication
All the patients included, as well as the hospital ethics committee, con consent for publication of the retrospective study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Wang, G., Li, Y., Liu, P. et al. Pelvic incidence correlates to sagittal spinal morphology in lenke 5 adolescent idiopathic scoliosis and influences the proximal junctional kyphosis rate after correction surgery. Eur Spine J (2021). https://doi.org/10.1007/s00586-021-06749-9
- Adolescent idiopathic scoliosis
- Lenke type 5
- Sagittal spinal morphology
- Proximal junctional kyphosis
- Pelvic incidence