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Preoperative Sagittal Spinal Profile of Adolescent Idiopathic Scoliosis Lenke Types and Non-Scoliotic Adolescents

A Systematic Review and Meta-Analysis

Pasha, Saba, PhD; Baldwin, Keith, MD

doi: 10.1097/BRS.0000000000002748

Study Design. Systematic review and meta-analysis.

Objective. This study aims to determine the differences in sagittal spinopelvic parameters between adolescent idiopathic scoliosis (AIS) Lenke types and non-scoliotic controls through a systematic review and meta-analysis of the available literature.

Summary of Background Data. AIS classification mainly focuses on frontal curve differences; however, the variations in the sagittal spinopelvic alignment in the current classification system is not fully established.

Methods. Following preferred reporting items for systematic reviews and meta-analyses guidelines, searches were performed for sagittal spinal and pelvic parameters of Lenke types and non-scoliotic controls in PubMed, Scopus, EMBASE, and Cochrane databases. Selection criteria were: (1) age range 10 to 21 years; (2) Lenke types 1–6 (for AIS group) or non-scoliotic adolescents (for the control group); (3) preoperative data for T5–T12 thoracic kyphosis (TK), L1–S1 lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and sagittal vertical axis (SVA). (4) Written in English language. PI–LL mismatch was calculated from the weighted average of PI and LL. Publication bias between studies and within studies quality were assessed. A meta-regression compared each measured variable between groups. Thoracic (Lenke1 and 2) and thoracolumbar/lumbar (Lenke 5 and 6) scoliosis were combined and statistically compared with the control group.

Results. Meta-analysis, including 81 AIS and 18 control studies, showed no significant differences in sagittal parameters between Lenke types and controls for LL, PI, PI–LL mismatch, SS, and SVA (P > 0.05). Publication bias was significant in Lenke 1 TK, Control LL, and Lenke 1, and 5 SVA. Stratification based on deformity region (thoracic vs. thoracolumbar/lumbar) showed no significant differences in sagittal spinopelvic parameters (P > 0.05).

Conclusion. No definitive difference was found between non-scoliotic adolescents and Lenke types in sagittal spinal and pelvic parameters. Future studies on developing a sagittal classification specific to AIS patients with a goal to improve surgical planning and outcome prediction are highly encouraged.

Level of Evidence: 4

Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Address correspondence and reprint requests to Saba Pasha, PhD, Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104; E-mail:

Received 11 December, 2017

Revised 10 April, 2018

Accepted 21 May, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants.

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