Assessment of Lowest Instrumented Vertebra Tilt on Radiographic Measurements in Lenke “C” Modifier Curves Undergoing Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis

Skaggs, David L.; Seehausen, Derek A.; Yamaguchi, Kent T.; Hah, Raymond J.; Wright, Margaret L.; Bumpass, David B.; Kim, Han J.; Andras, Lindsay M.; Vitale, Michael G.; Lenke, Lawrence G.

doi:10.1016/j.jspd.2015.08.006

Cited by 16 publications

(19 citation statements)

References 15 publications

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“…Ishikawa et al, reported that the final Cobb angle of the thoracolumbar/lumbar curve was significantly correlated with the immediately post-operative LIV tilt [ 26 ]. On the other hand, Skaggs et al, described that LIV tilt was not associated with post-surgical lumbar Cobb angle [ 27 ]. In our study, the Cobb angle of the lumbar curve and the LIV tilt were significantly improved until 10 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study

Uehara

Kuraishi

Ikegami

et al. 2020

JCM

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Skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS) requires fewer screws and can reduce the risk of neurovascular injury as compared with segmental pedicle screw fixation. However, the long-term impact of screw number reduction on correction and clinical results is unclear. This study examined the 10-year post-operative outcomes of skip pedicle screw fixation for patients with AIS. We reviewed the outcomes of 30 patients who underwent skip pedicle screw fixation for AIS. Radiological and clinical findings were assessed before and immediately, 2 years, and 10 years after surgery in the remaining 25 patients. The mean Cobb angle of the main curve preoperatively and immediately, 2 years, and 10 years post-operatively was 59.4°, 23.4°, 25.8°, and 25.60°, respectively, and was significantly improved at all post-surgical time points (all p < 0.001). The mean correction rate immediately after surgery was 60.8%, and the correction loss rate at the observation end point was 4.8%. The Cobb angle of the lumbar curve was significantly improved immediately after surgery, and the correction persisted until 10 years post-operatively. Remarkable gains were observed for most Scoliosis Research Society-22 patient questionnaire sub-scores at the final follow-up versus preoperative assessments. In conclusion, good correction of the AIS deformity by skip pedicle screw fixation was well maintained over a long follow-up period of 10 years, with clinically meaningful gains in Society-22 patient questionnaire sub-scores.

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Section: Discussionmentioning

confidence: 99%

Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study

Uehara

Kuraishi

Ikegami

et al. 2020

JCM

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“…Inappropriate curve selection and excessive thoracic correction have been identified as the most common etiologies of coronal imbalance [ 4 , 31 , 32 ]. Meanwhile, numerous studies [ 8 , 21 , 31 – 33 ] have demonstrated improper placement of the LIV is also an independent risk factor. It is also important to realize the heterogeneity of spontaneous compensation of unfused lumbar segments.…”

Section: Discussionmentioning

confidence: 99%

“…Lenke 1 and 2 adolescent idiopathic scoliosis (AIS) accounts for most AIS, but the optimal therapeutic approach for these patients remains controversial [ 1 ]. As posterior selective thoracic fusion (STF) has become the standard surgical treatment of choice [ 2 ], numerous studies have shown that proper STF can accomplish the underlying aim of preventing scoliosis progression while maintaining global balance [ 3 – 8 ]. In addition, the spontaneous lumbar curve correction (SLCC) can be achieved by correcting the main thoracic curve.…”

Section: Introductionmentioning

confidence: 99%

“…Although the spontaneous correction of the distal unfused lumbar curve after STF has been widely reported [ 1 , 13 – 20 ]; however, the impact of the spontaneous realignment of unfused segments on disc compensation remains to be quantified. To obtain an optimal balance outcome and prevent radiographical complications, such as the adding-on phenomenon, research has been conducted regarding the optimal LIV selection [ 8 , 21 ], prediction of SLCC [ 14 , 15 , 17 ] and related long-term outcome [ 6 , 22 ]. However, all these studies regarded the unfused distal segments as an ensemble.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics analysis of segmental and regional lumbar spontaneous compensation post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis

Chen

Zhai

Zhou

et al. 2021

BMC Musculoskelet Disord

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Objective To explore the characteristics of compensation of unfused lumbar region post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis. Background Preserving lumbar mobility in the compensation is significant in controlling pain and maintaining its functions. The spontaneous correction of the distal unfused lumbar curve after STF has been widely reported, but previous study has not concentrated on the characteristics of compensation of unfused lumbar region post thoracic fusion. Method A total of 51 Lenke 1 and2 AIS patients were included, whose lowest instrumented vertebrae was L1 from January 2013 to December 2019. For further analysis, demographic data and coronal radiographic films were collected before surgery, at immediate erect postoperatively and final follow-up. The wedge angles of each unfused distal lumbar segments were measured, and the variations in each disc segment were calculated at the immediate postoperative review and final follow-up. Meanwhile, the unfused lumbar curve was divided into upper and lower parts, and we calculated their curve angles and compensations. Results The current study enrolled 41 females (80.4%) and 10 males (19.6%). Thirty-six patients were Lenke type 1, while 15 patients were Lenke type 2. The average main thoracic Cobb angle and thoracolumbar/lumbar Cobb angle were 44.1 ± 7.7°and 24.1 ± 9.3°, preoperatively. At the final follow-up, the disc wedge angle variation of L1/2, L2/3, L3/4, L4/5 and L5/S1 was 3.84 ± 5.96°, 3.09 ± 4.54°, 2.30 ± 4.53°, − 0.12 ± 3.89° and − 1.36 ± 2.80°, respectively. The compensation of upper and lower coronal lumbar curves at final follow-up were 9.22 ± 10.39° and − 1.49 ± 5.14°, respectively. Conclusion When choosing L1 as the lowest instrumented vertebrae, the distal unfused lumbar segments’ compensation showed a decreasing trend from the proximal end to the distal end. The adjacent L1/2 and L2/3 discs significantly contributed to this compensation.

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“…Some studies that aimed to identify the appropriate LIV level on preoperative radiographs 1-6 demonstrated that a neutral and stable vertebra was the ideal LIV for preventing distal lumbar coronal curve decompensation. 3,4,7 In Lenke type 1A curves, surgeons may need to obtain maximum reduction of the apical translation of the main thoracic curve and to extend the LIV, at least to the last vertebra touching the central sacral vertical line (CSVL), in order to avoid postoperative distal lumbar coronal curve decompensation. 5 Even after selecting the correct LIV, decompensation can still occur, 8 indicating that other important factors, such as LIV tilt or LIV rotational angle (LIV rotation), should be…”

mentioning

confidence: 99%

Impact of lowest instrumented vertebra tilt and rotation on uninstrumented lumbar curve and L4 tilt in thoracic adolescent idiopathic scoliosis

Iwata

Sudo

Abumi

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEControversy exists regarding the effects of lowest instrumented vertebra (LIV) tilt and rotation on uninstrumented lumbar segments in adolescent idiopathic scoliosis (AIS) surgery. Because the intraoperative LIV tilt from the inferior endplate of the LIV to the superior sacral endplate is not stable after surgery, the authors measured the LIV angle of the instrumented thoracic spine as the LIV angle of the construct. This study aimed to evaluate the effects of the LIV angle of the construct and the effects of LIV rotation on the postoperative uninstrumented lumbar curve and L4 tilt in patients with thoracic AIS.METHODSA retrospective correlation and multivariate analysis of a prospectively collected, consecutive, nonrandomized series of patients at a single institution was undertaken. Eighty consecutive patients with Lenke type 1 or type 2 AIS treated with posterior correction and fusion were included. Preoperative and 2-year postoperative radiographic measurements were the outcome measures for this study. Outcome variables were postoperative uninstrumented lumbar segments (LIV tilt, LIV translation, uninstrumented lumbar curve, thoracolumbar/lumbar [TL/L] apical vertebral translation [AVT], and L4 tilt). The LIV angle of the construct was measured from the orthogonal line drawn from the upper instrumented vertebra to the LIV. Multiple stepwise linear regression analysis was conducted between outcome variables and patient demographics/radiographic measurements. There were no study-specific biases related to conflicts of interest.RESULTSPredictor variables for postoperative uninstrumented lumbar curve were the postoperative LIV angle of the construct, number of uninstrumented lumbar segments, and flexibility of TL/L curve. Specifically, a lower postoperative uninstrumented lumbar curve was predicted by a lower absolute value of the postoperative LIV angle of the construct (p < 0.0001). Predictor variables for postoperative L4 tilt were postoperative LIV rotation, preoperative L4 tilt, and preoperative uninstrumented lumbar curve. Specifically, a lower postoperative L4 tilt was predicted by a lower absolute value of postoperative LIV rotation (p < 0.0001).CONCLUSIONSThe LIV angle of the construct significantly affected the LIV tilt, uninstrumented lumbar curve, and TL/L AVT. LIV rotation significantly affected the LIV translation and L4 tilt.

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Assessment of Lowest Instrumented Vertebra Tilt on Radiographic Measurements in Lenke “C” Modifier Curves Undergoing Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis

Abstract: Level III, Therapeutic study.

Cited by 16 publications

References 15 publications

Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study

Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study

Characteristics analysis of segmental and regional lumbar spontaneous compensation post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis

Impact of lowest instrumented vertebra tilt and rotation on uninstrumented lumbar curve and L4 tilt in thoracic adolescent idiopathic scoliosis

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