A multicenter analysis of factors associated with change in height after adolescent idiopathic scoliosis deformity surgery in 447 patients

Author:

Hwang Steven W.1,Samdani Amer F.2,Lonner Baron S.3,Marks Michelle C.4,Bastrom Tracey P.5,Betz Randal R.2,Cahill Patrick J.2

Affiliation:

1. 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts;

2. 2Department of Orthopedics, Shriners Hospitals for Children, Philadelphia, Pennsylvania;

3. 3Department of Orthopedics, NYU Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York;

4. 4Setting Scoliosis Straight Foundation; and

5. 5Pediatric Orthopedic and Scoliosis Center, Rady Children's Hospital, San Diego, California

Abstract

Object In the surgical management of adolescent idiopathic scoliosis (AIS), patients are often preoperatively informed that they will gain height as a result of their surgery. However, current estimations conflict significantly and do not have any clinical correlation. The authors developed a formula that would predict postoperative gains in height after deformity correction in AIS. Methods A large, multicenter, prospective database was retrospectively queried for AIS patients with Lenke Type 1, 2, or 3 curves having undergone posterior spinal fusion alone. A univariate and multivariate analysis was performed to identify which factors contributed significantly to changes in height. Results Four hundred forty-seven patients were included in the series. Factors correlating with changes in postoperative height included: upper thoracic curve magnitude, main thoracic curve magnitude, lumbar curve magnitude, T2–12 kyphosis, T5–12 kyphosis, curve flexibility, number of levels fused, presence of Ponte osteotomies, total preoperative coronal Cobb angle, change in coronal curve magnitude, total preoperative sagittal curvature, change in sagittal curvature, and thoracic curve correction. When combined in a multivariate regression analysis the following variables remained significant: thoracic curve magnitude (p < 0.01), number of levels fused (p < 0.01), change in total sagittal curvature (p < 0.01), and the presence of osteotomies (p = 0.03). The contribution from the thoracic curve magnitude was significantly greater than any of the other parameters identified (R2 = 0.140). Change in height (in cm) = ([thoracic curve magnitude × 0.039] + [number of levels fused × 0.193] − [change in sagittal curvature × 0.033] + [x × 0.375]) − 1.858, where x = 1 if 1 or more osteotomies were performed and x = 0 if no osteotomy was performed. Conclusions The authors' results suggest that changes in the coronal plane contribute more significantly to height changes than those in the sagittal plane and approximately 0.39 cm of height gain can be expected for each 10° of coronal curve preoperatively. Unfortunately, a significant fraction of the postoperative height changes cannot be predicted by currently measured parameters.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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