Resumo

PASCOAL, Diogo et al. Hipocifose Torácica: Mito ou Realidade?. Rev. Port. Ortop. Traum. [online]. 2019, vol.27, n.1, pp.23-30. ISSN 1646-2122.

The importance of sagittal balance in the surgical treatment of adolescent idiopathic scoliosis is being increasingly relevant in the literature. Recent scientific evidence points to a correlation between post-surgical thoracic hypokyphosis (flatback syndrome) and chronic pain. Our objective was to evaluate the existence of hypokyphosing effect in surgery for the treatment of adolescent idiopathic scoliosis and the amplitude of this effect in the deformity, with aggravation or correction. The authors present a retrospective study of patients with adolescent idiopathic scoliosis who underwent posterior transpedicular instrumentation over a 6-year period, with evaluation of demographic and radiological variables in the coronal and sagittal plane. 107 patients were included, divided into 3 groups according to the degree of preoperative kyphosis: Group I - Hypokyphosis (n=16), mean kyphosis of 10.31±6.14; Group II - Normokyphosis  (n=50), mean kyphosis of 31.85±5.40 and Group III - Hyperkyphosis (n= 41), mean kyphosis of 51.71±7.89. Surgical scoliosis treatment had a significant effect on post-operative kyphosis (p=0.0002), and at 15 months of mean follow-up (p=0.04). The surgery had an effective correction of the kyphotic deformity: in the group I - Hypokyphosis, with kyphosing effect (p=0.000007); in the group III - Hyperkyphosis, with lordosing effect (p=0.00000004); in the group II, control group, normokyphosis was maintained (p=0.38). Factors previously identified as potential influencers, such as age (p> 0.05),  gender (p=0.48), preoperative scoliotic Cobb (R=0.178), preoperative column flexibility in the coronal plane (R=-0.024), and Cincinnati index (R=-0.0009) had no statistical correlation with kyphosis correction. Surgical treatment for adolescent idiopathic scoliosis with posterior transpedicular instrumentation, in addition to correction in the coronal plane, allows effective correction in the sagittal plane.

Palavras-chave : Scoliosis; thoracic hypokyphosis; sagital balance.

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