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

Article dans une revue avec comité de lecture
Author
KARAM, Mohamad
301405 Université Saint-Joseph de Beyrouth [USJ]
GHANEM, Ismat
301405 Université Saint-Joseph de Beyrouth [USJ]
VERGARI, Claudio
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
KHALIL, Nour
301405 Université Saint-Joseph de Beyrouth [USJ]
SAADE, Maria
301405 Université Saint-Joseph de Beyrouth [USJ]
CHAAYA, Céline
301405 Université Saint-Joseph de Beyrouth [USJ]
RTEIL, Ali
301405 Université Saint-Joseph de Beyrouth [USJ]
AYOUB, Elma
301405 Université Saint-Joseph de Beyrouth [USJ]
SAAD, Eddy
301405 Université Saint-Joseph de Beyrouth [USJ]
KHARRAT, Khalil
301405 Université Saint-Joseph de Beyrouth [USJ]
SKALLI, Wafa
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
ASSI, Ayman
301405 Université Saint-Joseph de Beyrouth [USJ]
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]

URI
http://hdl.handle.net/10985/21536
DOI
10.1007/s00586-021-07101-x
Date
2022
Journal
European Spine Journal

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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