Assessment of sagittal balance parameters in adolescents with severe thoracic idiopathic scoliosis

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Abstract

BACKGROUND: In recent years, the concept of sagittal balance has become increasingly important in the treatment of spinal deformities of various etiologies. However, the number of studies analyzing sagittal balance parameters in patients with idiopathic scoliosis is limited, especially those involving individuals with severe deformities.

AIM: This study aimed to evaluate global and regional sagittal balance parameters in adolescents with severe thoracic idiopathic scoliosis.

METHODS: The study included 45 patients aged 12–17 years diagnosed with thoracic idiopathic scoliosis (Lenke types 1, 2, and 3), presenting with a primary curve magnitude ranging from 80° to 150°, according to the Cobb method. Radiographic examinations were performed to assess both regional and global sagittal balance parameters, as well as characteristics of frontal plane spinal deformity. The patients were divided into two groups based on the global sagittal balance values. Descriptive, correlation, regression, and comparative statistical analyses of the data were conducted.

RESULTS: A positive correlation was observed between the magnitude of frontal plane spinal deformity and thoracic kyphosis values. The regression analysis indicated that when the primary curve exceeded approximately 100°, thoracic kyphosis values tended to rise above 60°. Thoracic hyperkyphosis was the predominant sagittal deformity in these patients; however, neither thoracic kyphosis nor the primary curve magnitude in the frontal plane showed statistically significant correlation with any of the global sagittal balance indicators. These indicators correlated more strongly with spinopelvic parameters (pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and PI–LL).

CONCLUSION: Surgical treatment of severe idiopathic scoliosis should obligatorily consider correction methods that produce a corrective effect on the kyphotic component of the deformity. The development of pronounced anterior imbalance has been proven to be uncharacteristic for patients with thoracic idiopathic scoliosis, even with the largest primary curve magnitudes. The primary risk factors for its development were reduced PI and LL values. The development mechanism of the observed association in these patients remains unclear.

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About the authors

Sergei V. Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930

MD, PhD, Dr. Sci. (Medicine), Professor, Corresponding Member of RAS

Russian Federation, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Timofey S. Rybinskikh

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: timofey1999r@gmail.com
ORCID iD: 0000-0002-4180-5353
SPIN-code: 7739-4321

MD

Russian Federation, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Marat S. Asadulaev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: marat.asadulaev@yandex.ru
ORCID iD: 0000-0002-1768-2402
SPIN-code: 3336-8996

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Dmitriy N. Kokushin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: partgerm@yandex.ru
ORCID iD: 0000-0002-2510-7213
SPIN-code: 9071-4853

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Sergei M. Belyanchikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: beljanchikov@list.ru
ORCID iD: 0000-0002-7464-1244
SPIN-code: 9953-5500

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Vakhtang G. Toria

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: vakdiss@yandex.ru
ORCID iD: 0000-0002-2056-9726
SPIN-code: 1797-5031

MD

Russian Federation, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

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Supplementary files

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2. Fig. 1. Distribution of patients by types of deformation, according to the Lenke classification: A, B, C — lumbar modifiers according to the Lenke classification.

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3. Fig. 2. Results of regression analysis reflecting the relationship between the measured radiographic parameters: a — between the magnitude of the primary curvature arc and thoracic kyphosis (TK) (R=0.72; R2=0.51); b — between TK and lumbar lordosis (LL) (R=0.41; R2=0.17); c — between LL and the spinal sacral angle (SSA) (R=0.69; R2=0.48); d — between SSA and the pelvic angle (PI) (R=0.66; R2=0.44).

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4. Fig. 3. Patient, 17 years old. Diagnosis: Idiopathic S-shaped scoliosis of the IV degree (Lenke 3B). The magnitude of the primary curve is 135°, secondary curve of the lumbar spine is 70°, rotation of the apical vertebra is 87°, thoracic kyphosis is 116°, lumbar lordosis (LL) is 102°, pelvic angle (PI) is 43°, pelvic deviation (PT) is 0°, sacral tilt (SS) is 43°, the difference between the values ​​of the pelvic index and lumbar lordosis (PI–LL) is –58°, spinal sacral angle (SSA) is 140°, T1/pelvic angle is –6°, sagittal vertical axis (SVA) is –21 mm.

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