Selective Thoracic Fusion of XXXX and II Curves Affects Sagittal Profiles But Not Sagittal or Spinopelvic Alignment: A Case-Control Study.

@entity1 @entity1605 @entity1615 @entity1513 @entity196 @entity1515 @entity85
STUDY DESIGN: Literature review and retrospective case-control study (level 3 evidence) examining 50 @entity1615 ( @entity1615 ) ( @entity196 or II curve) cases with 32 healthy controls of the same age. The sagittal profiles were measured preoperatively, 6 months, and 2 years after surgery and compared with those of age-matched controls at baseline. OBJECTIVE: The purpose of this study is to compare baseline sagittal profiles of @entity1615 @entity1605 with age-matched healthy controls and at 6 months and 2 years after surgery, as well as with previously published reports. SUMMARY OF BACKGROUND DATA: Sagittal alignment and profiles have gained significant attention in @entity85 outcomes. The sagittal profile of @entity1 with @entity1615 has been previously reported, as well as the effects of surgical correction, with inconsistent results and no clear references to nonscoliotic controls. METHODS: Baseline sagittal profiles of 50 @entity1 presenting with @entity1615 treated with selective thoracic fusion were compared with 32 age-matched controls without spinal pathology. These values were also measured at 6 months and 2 years postoperatively to examine effects of selective thoracic fusion over time. Sagittal parameters examined include pelvic incidence, pelvic tilt, C7 plumb line (sagittal vertical alignment), @entity1513 , and @entity1515 . A literature review was performed comparing previously published data. Data are presented as mean (95% confidence interval). P value of less than 0.05 was considered significant. RESULTS: Interobserver reliability (Cohen k= 0.49-0.95). All demographic and preoperative sagittal alignment parameters were comparable between controls and @entity1 with @entity1615 prior to surgery. After selective thoracic fusion, @entity1513 decreased significantly from baseline (25.4   [21.6-29.2] vs. 15.3   [12.8-17.8]; P < 0.001) at 6 months and at 2 years (10.3   [7.5-13.1]; P < 0.001). The @entity1515 significantly decreased at 6 months from baseline (54.5   [28.6-80.5] vs. 61.8   (33.4-90.1); P < 0.001) and at 2 years (55.4   [29.0-81.9]; P < 0.001). Sagittal vertical alignment, pelvic tilt, and pelvic incidence were comparable between controls and @entity1 with @entity1615 at baseline and did not change with surgery. CONCLUSIONS: Adolescents with @entity1605 have comparable sagittal profiles with those of healthy controls of the same age. This suggests that @entity1605 may not be hypokyphotic as previously thought. After selective thoracic fusion, @entity1 with @entity1615 have a significantly decreased @entity1513 , which is accompanied by reciprocal changes in the noninstrumented lumbar curve. Sagittal vertical alignment and pelvic tilt are not significantly affected. These results agree with previous reports, which suggest that constructs with pedicle screws have a higher impact on sagittal curves but do not affect sagittal or spinopelvic alignment. The long-term effects of abnormal sagittal profiles need further clarification. LEVEL OF EVIDENCE: 3.
