Preliminary Results of Instantaneous Centre of Rotation Change after Thoracic Instrumentation in Adolescent Idiopathic Scoliosis Patients.

ABSTRACT

Introduction: The instantaneous centre of rotation (ICR) is the centre of motion with zero velocity where a rigid body moves in a particular plane. ICR, as a dynamic measurement, gives more accurate results in terms of quality and quantity of the vertebral motions compared to range of motion (ROM). We aimed to determine the effect of thoracic instrumentation on cervical movement of adolescent idiopathic scoliosis (AIS) patients who had undergone thoracic level instrumentation by measuring pre-operative and post-operative ICR change in a pilot study. Materials and methods: A total of 25 AIS patients were included in this study. C4-C5 and C6-C7 segmental ICR were determined by pre-operative and post-operative cervical flexion-extension radiographs. In addition, cervical sagittal parameters and global sagittal parameters were investigated. Results: There was no statistically significant change in ICR location post-operatively in both x and y coordinates at C4-C5 segment (p 0.326 and p 0.946, respectively) and C6-C7 segment (p 0.209, p 0.086, respectively). There was a positive correlation between LCL and C4-C5 ICR y coordinate (r 0.481), but not with C6-C7 ICR y coordinate (r -0.2, p 0.398). T5-T12 kyphosis decreased (p 0.002) and T1 pelvic angle (0.003), SVA (0.02) and sacral slope (0.049) increased significantly post-operatively. T1S was correlated with LCL (r 0.595, p 0.002), T5-T12 kyphosis (r 0.423, p 0.035), SVA (r 0.658, p<0.001) and C2-C7 SVA (r 0.416, p 0.039). Conclusion: The ICR for cervical region was not changed post-operatively in AIS patients with thoracic instrumentation. There was no relationship found between the development of post-operative cervical kyphosis or lordosis and ICR, which represents the quality and quantity of intervertebral motion. The T1 vertebra plays a key role for cervical, thoracic, and global parameters interaction.