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05.01.2022 | Original Article

Global malalignment in adolescent idiopathic scoliosis: the axial deformity is the main driver

verfasst von: Mohamad Karam, Ismat Ghanem, Claudio Vergari, Nour Khalil, Maria Saadé, Céline Chaaya, Ali Rteil, Elma Ayoub, Eddy Saad, Khalil Kharrat, Wafa Skalli, Ayman Assi

Erschienen in: European Spine Journal | Ausgabe 9/2022

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Abstract

Purpose

To evaluate the global alignment of non-operated subjects with adolescent idiopathic scoliosis.

Method

A total of 254 subjects with AIS and 64 controls underwent low dose biplanar X-rays and had their spine, pelvis, and rib cage reconstructed in 3D. Global alignment was measured in the sagittal and frontal planes by calculating the OD-HA angle (between C2 dens to hip axis with the vertical). Subjects with AIS were classified as malaligned if the OD-HA was > 95th percentile relative to controls.

Results

The sagittal OD-HA in AIS remained within the normal ranges. In the frontal plane, 182 AIS were normally aligned (Group 1, OD-HA = 0.9°) but 72 were malaligned (Group 2, OD-HA = 2.9°). Group 2 had a more severe spinal deformity in the frontal and horizontal planes compared to Group 1 (Cobb: 42 ± 16° vs. 30 ± 18°; apical vertebral rotation AVR: 19 ± 10° vs. 12 ± 7°, all p < 0.05). Group 2 subjects were mainly classified as Lenke 5 or 6. 19/72 malaligned subjects had a mild deformity (Cobb < 30°) but a progressive scoliosis (severity index ≥ 0.6). The frontal OD-HA angle was found to be mainly determined (adjusted-R² = 0.22) by the apical vertebral rotation and secondarily by the Lenke type.

Conclusions

This study showed that frontal malalignment is more common in distal major structural scoliosis and its main driver is the apical vertebral rotation. This highlights the importance of monitoring the axial plane deformity in order to avoid worsening of the frontal global alignment.

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Titel: Global malalignment in adolescent idiopathic scoliosis: the axial deformity is the main driver
verfasst von: Mohamad Karam
Ismat Ghanem
Claudio Vergari
Nour Khalil
Maria Saadé
Céline Chaaya
Ali Rteil
Elma Ayoub
Eddy Saad
Khalil Kharrat
Wafa Skalli
Ayman Assi
Publikationsdatum: 05.01.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 9/2022
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-021-07101-x

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Global malalignment in adolescent idiopathic scoliosis: the axial deformity is the main driver