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A three-dimensional analysis of scoliosis progression in non-idiopathic scoliosis: is it similar to adolescent idiopathic scoliosis?

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Abstract

Purpose

To evaluate the three-dimensional (3D) characteristics of spine deformity in patients with non-idiopathic scoliosis compared with those observed in patients with adolescent idiopathic scoliosis (AIS).

Methods

A retrospective chart review was conducted to identify patients with non-idiopathic scoliosis. Twenty-eight patients with neural axis (NA) abnormalities (Chiari 1, syrinx) and 20 patients with connective tissue disorder (CTD) (Marfan’s, Beal’s, Ehlers-Danlos syndrome, mixed) were identified. The 3D parameters of the coronal, sagittal, and axial plane were compared with 284 AIS patients with a similar range of coronal deformity.

Results

The average coronal curve was similar between all three groups (AIS 48 ± 15°, CTD 43 ± 22°, and NA 49 ± 18°; p = 0.4). The NA patients had significantly greater 3D thoracic kyphosis (20 ± 18° vs 10 ± 15°, p = 0.001) and less thoracic apical vertebral rotation (− 5 ± 18° vs − 12 ± 10°, p = 0.003) when compared with AIS. The CTD group’s 3D thoracic kyphosis (p = 0.7) and apical vertebral rotation (p = 0.09) did not significantly differ from AIS. Significant negative correlations were found in all three groups between thoracic kyphosis and coronal curve magnitude (AIS r = − 0.49, CTD r = − 0.772, NA r = −0.677, all p < 0.001).

Conclusions

Scoliotic patients with NA abnormalities have a more kyphotic, less-rotated 3D profile than patients with AIS, while scoliosis patients with CTD have 3D features similar to AIS. Irrespective of the underlying diagnosis, however, greater scoliotic curves were associated with a greater loss of intersegmental kyphosis, suggesting a similar biomechanical pathophysiology for curve progression.

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Acknowledgements

Harms Study Group Investigators:

Aaron Buckland, MD; New York University

Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia

Amit Jain, MD; Johns Hopkins Hospital

Baron Lonner, MD; Mount Sinai Hospital

Benjamin Roye, MD; Columbia University

Burt Yaszay, MD; Rady Children’s Hospital

Chris Reilly, MD; BC Children’s Hospital

Daniel Hedequist, MD; Boston Children’s Hospital

Daniel Sucato, MD; Texas Scottish Rite Hospital

David Clements, MD; Cooper Bone & Joint Institute New Jersey

Firoz Miyanji, MD; BC Children’s Hospital

Harry Shufflebarger, MD; Nicklaus Children’s Hospital

Jack Flynn, MD; Children’s Hospital of Philadelphia

Jahangir Asghar, MD; Cantor Spine Institute

Jean Marc Mac Thiong, MD; CHU Sainte-Justine

Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia

Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad

Keith Bachmann, MD; University of Virginia

Larry Lenke, MD; Columbia University

Mark Abel, MD; University of Virginia

Michael Glotzbecker, MD; Boston Children’s Hospital

Michael Kelly, MD; Washington University

Michael Vitale, MD; Columbia University

Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation

Munish Gupta, MD; Washington University

Nicholas Fletcher, MD; Emory University

Patrick Cahill, MD; Children’s Hospital of Philadelphia

Paul Sponseller, MD; Johns Hopkins Hospital

Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children

Peter Newton, MD; Rady Children’s Hospital

Peter Sturm, MD; Cincinnati Children’s Hospital

Randal Betz, MD; Institute for Spine & Scoliosis

Ron Lehman, MD; Columbia University

Stefan Parent, MD: CHU Sainte-Justine

Stephen George, MD; Nicklaus Children’s Hospital

Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia

Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children

Tom Errico, MD; Nicklaus Children’s Hospital

Vidyadhar Upasani, MD; Rady Children’s Hospital

Funding

Research support is gratefully acknowledged from the Rady Children’s Foundation Assaraf Family Research Fund and from funding to the Setting Scoliosis Straight Foundation from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet in support of Harms Study Group Research.

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Authors and Affiliations

  1. Department of Orthopedics, University of Virginia Medical Center, Charlottesville, VA, USA

    Keith R. Bachmann

  2. Department of Orthopedics, Rady Children’s Hospital, 3030 Children’s Way, MC5062, San Diego, CA, 92123, USA

    Burt Yaszay, Carrie E. Bartley, Tracey P. Bastrom, Fredrick G. Reighard, Vidyadhar V. Upasani & Peter O. Newton

  3. Department of Orthopedics, University of California, San Diego, CA, USA

    Burt Yaszay, Vidyadhar V. Upasani & Peter O. Newton

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  1. Keith R. Bachmann
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Harms Study Group Investigators

Corresponding author

Correspondence to Burt Yaszay.

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Conflict of interest

Dr. Bachmann reports funding to his institution from Setting Scoliosis Straight, during the conduct of this study; personal fees from Nuvasive, outside the submitted work.

Dr. Yaszay reports grants to his institution from the Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M, grants and personal fees from DePuy Synthes Spine, grants and personal fees from Nuvasive, personal fees from Medtronic, grants and personal fees from Orthopediatrics, personal fees from Stryker, personal fees from Globus, grants from Setting Scoliosis Straight Foundation, personal fees from Biogen, outside the submitted work. In addition, Dr. Yaszay has a patent K2M with royalties paid.

Dr. Upasani reports grants to his institution from the Setting Scoliosis Straight Foundation, during the conduct of this study; personal fees from DePuy Synthes Spine, personal fees from OrthoPediatrics, outside the submitted work.

Dr. Newton reports grants to his institution from the Setting Scoliosis Straight Foundation (SSSF receives grants from from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet in support of Harms Study Group research), during the conduct of the study; grants and other from the Setting Scoliosis Straight Foundation, other from the Rady Children’s Specialists, grants, personal fees and non-financial support from the DePuy Synthes Spine, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, grants from NuVasive, other from Electrocore, personal fees from Cubist, other from International Pediatric Orthopedic Think Tank, grants, non-financial support and other from Orthopediatrics, grants, personal fees and non-financial support from K2M, grants and non-financial support from Alphatech, grants from Mazor Robotics, outside the submitted work; In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) licensed to DePuy Spine, Inc., a patent Screw placement guide (7981117) licensed to DePuy Spine, Inc., a patent compressor for use in minimally invasive surgery (7189244) licensed to DePuy Spine, Inc., and a patent posterior spinal fixation pending to K2M.

All remaining authors report funding to their institutions from the Setting Scoliosis Straight Foundation, during the conduct of this study; no other conflicts of interest, outside the submitted work.

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This study was conducted at Rady Children’s Hospital, San Diego, CA.

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Bachmann, K.R., Yaszay, B., Bartley, C.E. et al. A three-dimensional analysis of scoliosis progression in non-idiopathic scoliosis: is it similar to adolescent idiopathic scoliosis?. Childs Nerv Syst 35, 1585–1590 (2019). https://doi.org/10.1007/s00381-019-04239-4

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