Selection of the upper vertebra to be instrumented in the treatment of thoracolumbar and lumbar adolescent idiopathic scoliosis by anterior correction and fusion surgery using dual-rod instrumentation: a minimum 12-year follow-up study

OBJECTIVE L3 is most often selected as the lowest instrumented vertebra (LIV) to conserve mobile segments in fusion surgery; however, in cases with the lowest end vertebra (LEV) at L4, LIV selection as L3 could have a potential risk of correction loss and coronal decompensation. This study aimed to compare the clinical and radiographic outcomes depending on the LEV in adolescent idiopathic scoliosis (AIS) patients with Lenke type 5C curves. METHODS Data from 49 AIS patients with Lenke type 5C curves who underwent selective thoracolumbar/lumbar (TL/L) fusion to L3 as the LIV were retrospectively analyzed. The patients were classified according to their LEVs into L3 and L4 groups. In the L4 group, subanalysis was performed according to the upper instrumented vertebra (UIV) level toward the upper end vertebra (UEV and 1 level above the UEV [UEV+1] subgroups). Radiographic parameters and clinical outcomes were compared between these groups. RESULTS Among 49 patients, 32 and 17 were in the L3 and L4 groups, respectively. The L4 group showed a lower TL/L curve correction rate and a higher subjacent disc angle postoperatively than the L3 group. Although no intergroup difference was observed in coronal balance (CB), the L4 group showed a significantly higher main thoracic (MT) and TL/L curve progression during the postoperative follow-up period than the L3 group. In the L4 group, the UEV+1 subgroup showed a higher absolute value of CB at 2 years than the UEV subgroup. CONCLUSIONS In Lenke type 5C AIS patients with posterior selective TL/L fusion to L3 as the LIV, patients with their LEVs at L4 showed postoperative MT and TL/L curve progression; however, no significant differences were observed in global alignment and clinical outcome.

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Does Selective Posterior Correction and Fusion Surgery Influence Cervical Sagittal Alignment In Patient With Lenke Type 5 Adolescent Idiopathic Scoliosis? - A 5-Year Follow Up Retrospective Cohort Study

Spine ◽

10.1097/brs.0000000000003967 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Toshiki Okubo ◽

Mitsuru Yagi ◽

Satoshi Suzuki ◽

Satoshi Nori ◽

Osahiko Tsuji ◽

...

Keyword(s):

Cohort Study ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Sagittal Alignment ◽

Fusion Surgery ◽

Cervical Sagittal Alignment ◽

Posterior Correction

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Preoperative pelvic obliquity: possible relation to postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2021.4.spine21265 ◽

2021 ◽

pp. 1-10

Author(s):

Tomohiro Banno ◽

Yu Yamato ◽

Hiroki Oba ◽

Tetsuro Ohba ◽

Tomohiko Hasegawa ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Clinical Outcomes ◽

Pelvic Obliquity ◽

Posterior Fusion ◽

Lumbar Curve ◽

Fusion Surgery ◽

The Right ◽

Coronal Decompensation

OBJECTIVE Pelvic obliquity is frequently observed in patients with adolescent idiopathic scoliosis with thoracolumbar/lumbar (TL/L) curve. This study aimed to assess pelvic obliquity changes and their effects on clinical outcomes of posterior fusion surgery. METHODS Data in 80 patients (69 with type 5C and 11 with type 6C adolescent idiopathic scoliosis) who underwent posterior fusion surgery were retrospectively analyzed. Pelvic obliquity was defined as an absolute pelvic obliquity angle (POA) value of ≥ 3°. The patients were divided into groups according to preoperative pelvic obliquity. Moreover, patients with preoperative pelvic obliquity were divided based on POA change from preoperative values versus 2 years postoperatively. Patients were divided based on the presence of selective or nonselective TL/L fusion. Radiographic parameters and clinical outcomes were compared between these groups. RESULTS Among 80 patients, 41 (51%) showed preoperative pelvic obliquity, and its direction was upward to the right for all cases. Coronal decompensation 2 years postoperatively was significantly elevated in patients with preoperative pelvic obliquity (p < 0.05). Thirty-two patients (40%) displayed pelvic obliquity 2 years postoperatively. Among 41 patients with preoperative pelvic obliquity, 22 patients (54%) were in the group with a decrease in POA, and 19 were in the group with no decrease. The group with no decrease in POA showed significant TL/L curve progression throughout the postoperative follow-up period. The patients with nonselective fusion showed a significantly lower incidence of pelvic obliquity at 2 years postoperatively. CONCLUSIONS Postoperative coronal decompensation more frequently occurred in patients with preoperative pelvic obliquity than in those without pelvic obliquity preoperatively. In addition, postoperative pelvic obliquity changes may be related to residual lumbar curve behavior.

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The Influence of Lumbar Muscle Volume on Curve Progression After Skeletal Maturity in Patients With Adolescent Idiopathic Scoliosis: A Long-Term Follow-up Study

Spine Deformity ◽

10.1016/j.jspd.2018.04.003 ◽

2018 ◽

Vol 6 (6) ◽

pp. 691-698.e1 ◽

Cited By ~ 6

Author(s):

Kei Watanabe ◽

Masayuki Ohashi ◽

Toru Hirano ◽

Keiichi Katsumi ◽

Hirokazu Shoji ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Skeletal Maturity ◽

Muscle Volume ◽

Curve Progression ◽

Follow Up Study ◽

Long Term Follow Up ◽

Lumbar Muscle

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Predicted final spinal height in patients with adolescent idiopathic scoliosis can be achieved by surgery regardless of maturity status

The Bone & Joint Journal ◽

10.1302/0301-620x.100b10.bjj-2017-1540.r2 ◽

2018 ◽

Vol 100-B (10) ◽

pp. 1372-1376 ◽

Cited By ~ 4

Author(s):

H. Bao ◽

Z. Liu ◽

M. Bao ◽

Z. Zhu ◽

P. Yan ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Growth Restriction ◽

Fusion Surgery ◽

Group 4 ◽

Selective Fusion ◽

Group 3 ◽

Group 2 ◽

Group 1

Aims The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. Patients and Methods The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOSf) and height of pelvis at follow-up (HOPf) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOPf. One-way analysis of variance (ANOVA) was performed for statistical analysis. Results Of the 152 patients, there were 32 patients in Group 1, 27 patients in Group 2, 48 patients in Group 3, and 45 patients in Group 4. Significantly greater HOSf was observed in Group 3 compared with Group 1 (p = 0.03) and in Group 4 compared with Group 2 (p = 0.02), with similar HOPf (p = 0.75 and p = 0.83, respectively), suggesting that patients who undergo surgery at Risser grade of 0 to 1 have a shorter spinal height at follow-up than those who have surgery at Risser 4 to 5. HOSf was similar to pHOS in both Group 1 and Group 2 (p = 0.62 and p = 0.45, respectively), indicating that undergoing surgery at Risser 0 to 1 does not necessarily affect final spinal height. Conclusion This study shows that fusion surgery at Risser 0 may result in growth restriction unlike fusion surgery at Risser 3 to 4. Despite such growth restriction, AIS patients could reach their predicted or ‘normal’ spinal height after surgery regardless of baseline maturity status due to the longer baseline spinal length in AIS patients and the remaining growth potential at the non-fusion levels. Cite this article: Bone Joint J 2018;100-B:1372–6.

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