Predicting the risk of insufficient correction of the lumbar countercurve in surgical treatment of patients with severe idiopathic scoliosis with a primary thoracic curve

Objective. To identify the factors affecting the degree of lumbar countercurve correction, in order to predict the risks of its insufficient correction during surgical treatment of severe idiopathic scoliosis with a primary thoracic curve.

Material and Methods. The outcomes of treatment of 168 patients with idiopathic scoliosis with a median thoracic curve of 90.5° and lumbar countercurve of 62.0° operated on in 1999–2021, were analyzed. The median postoperative follow-up period was 4.6 years. Logistic regression models were used to identify predictors of insufficient lumbar countercurve correction.

Results. Taking into account the lumbar countercurve correction magnitude, patients were divided into two groups: less than 50% of the initial magnitude (n = 62; 36.9%) and more than 50% of the initial magnitude (n = 101; 60.1%). Significant differences were found in the groups in gender (men, 26.0% vs 11.9%), age (16.0 vs 14.0 years; p < 0.001), and countercurve mobility (36.7 vs 47.6%; p < 0.001). Building single-factor logistic regression models allowed identifying predictors of insufficient correction: countercurve more than 37.5°, age more than 15.8 years, male gender, and countercurve mobility less than 31.4%. A formula based on a multivariate model was developed to predict the risk of insufficient correction of the lumbar countercurve with a sensitivity of 73.8%.

Conclusion. The combination of factors including lumbar countercurve greater than 37.7°, its mobility less than 31.4%, male gender, scapular tilt less than 12.0°, and a plumb-to-umbilicus distance less than 5 mm allows for predicting the risk of lumbar countercurve correction of less than 50% with a diagnostic accuracy of 81.0%.

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