Clinical Presentation
The study highlights the importance of assessing coronal truncal inclination alongside traditional radiographic parameters to better understand the clinical impact on patients with thoracolumbar scoliosis [PMID:31981146].
Diagnosis
The study utilized Bao's classification (type A, B, C) to categorize patients, highlighting that type C patients exhibit significantly greater lumbosacral fractional curves, aiding in preoperative assessment [PMID:33651338].
Management
Patients with type C coronal imbalance (CSVL > 3 cm and C7 plumb line shifted to scoliosis convexity) often require additional transverse lumbar interbody fusions (TLIFs) to address persistent coronal malalignment post-surgery [PMID:33651338].
Patients categorized as Type B with GCM >3 cm toward the concave side exhibited significantly worse functional scores, including higher Oswestry Disability Index and lower Scoliosis Research Society-22 scores compared to those with less severe malalignment [PMID:31981146].
Soucy et al. (PMID:1812267) advocate for the routine use of muscle-sparing thoracotomy techniques in infants and children to reduce sequelae such as chest wall and spinal deformities, preserving muscle integrity and function.
Soucy et al. (PMID:1812267) note that muscle-sparing techniques not only minimize deformities but also offer benefits such as lessened postoperative pain and improved respiratory function in pediatric surgical patients.
Complications
According to Soucy et al. (PMID:1812267), major thoracotomies that transect muscles and divide motor nerves often result in chest wall, breast, shoulder girdle, and spinal deformities, which are likely worsened by the growth process.
Prognosis & Follow-up
Among type C patients preoperatively, 67% maintained type C status and 33% improved to type A postoperatively, indicating ongoing challenges in achieving optimal alignment [PMID:33651338].
Type B patients with GCM >3 cm toward the concave side showed more severe coronal deformities and worse functional outcomes, suggesting a poorer prognosis without targeted corrective interventions [PMID:31981146].
References
1 Theologis AA, Lertudomphonwanit T, Lenke LG, Bridwell KH, Gupta MC. The role of the fractional lumbosacral curve in persistent coronal malalignment following adult thoracolumbar deformity surgery: a radiographic analysis. Spine deformity 2021. link 2 Plais N, Bao H, Lafage R, Gupta M, Smith JS, Shaffrey C et al.. The clinical impact of global coronal malalignment is underestimated in adult patients with thoracolumbar scoliosis. Spine deformity 2020. link 3 Soucy P, Bass J, Evans M. The muscle-sparing thoracotomy in infants and children. Journal of pediatric surgery 1991. link90611-v)