Choosing Fusion Levels in Adolescent Idiopathic Scoliosis

Trobisch, Per; Ducoffe, Aaron R.; Lonner, Baron S.; Errico, Thomas J.

doi:10.5435/00124635-201309020-00003

Cited by 26 publications

(62 citation statements)

References 36 publications

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“…Three methods of UIV selection with regard to shoulder balance were found after a review of the literature: Lenke [18], Ilharreborde [11], and Trobisch [29]. Appropriate radiographic measurements of pre-surgical radiographs were taken, and a recommended UIV was determined for each methodology for every patient.…”

Section: Methodsmentioning

confidence: 99%

“…A recent review from Trobisch [29] uses curve type and pre-surgical shoulder balance only to create a simplified algorithm for UIV selection. For Lenke curve types 1, 3, or 6, the recommended UIV is to T2 for left shoulder elevation, T3 for level shoulders, and T4 (or below) for left shoulder elevation.…”

Section: Description Of Recommendationsmentioning

confidence: 99%

“…A table was devised for inclusion of the curve to T1, partial inclusion to T2 or T3, or no inclusion (T4 or below). A recent review from Trobisch [29] uses only curve type and presurgical shoulder balance to create a simplified algorithm for UIV selection.…”

Section: Introductionmentioning

confidence: 99%

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Do Current Recommendations for Upper Instrumented Vertebra Predict Shoulder Imbalance? An Attempted Validation of Level Selection for Adolescent Idiopathic Scoliosis

et al. 2015

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Background: Shoulder balance for adolescent idiopathic scoliosis (AIS) patients is associated with patient satisfaction and self-image. However, few validated systems exist for selecting the upper instrumented vertebra (UIV) post-surgical shoulder balance. Questions/Purposes: The purpose is to examine the existing UIV selection criteria and correlate with post-surgical shoulder balance in AIS patients. Methods: Patients who underwent spinal fusion at age 10-18 years for AIS over a 6-year period were reviewed. All patients with a minimum of 1-year radiographic followup were included. Imbalance was determined to be radiographic shoulder height |RSH|≥15 mm at latest follow-up.

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Section: Methodsmentioning

confidence: 99%

Section: Description Of Recommendationsmentioning

confidence: 99%

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Do Current Recommendations for Upper Instrumented Vertebra Predict Shoulder Imbalance? An Attempted Validation of Level Selection for Adolescent Idiopathic Scoliosis

et al. 2015

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“…Therefore, we used it as a backbone to develop that SSRBA. Yet, as stated by Trobisch et al [58], existing treatment algorithms do not account for every exception, and further research is required to improve long-term surgical outcomes. It is with this goal in mind that this study was undertaken.…”

Section: Discussionmentioning

confidence: 93%

“…Therefore, due to ongoing improvements in instrumentation and classification, protocols often are outdated before they have been validated [58]. In doing an extensive literature review and including all peer-reviewed validated rules, that SSRBA was developed, yet some rules such as the extension of the distal level of fusion to L3 or L4 in complex curve types are still heavily debated.…”

Section: Discussionmentioning

confidence: 99%

A rule-based algorithm can output valid surgical strategies in the treatment of AIS

et al. 2015

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This study is to the author's knowledge the first attempt at proposing an algorithm to output all surgical alternatives for a given AIS case. It uses a rule-based algorithm with a knowledge base extracted from peer-reviewed literature in an area with great variability. When tested against a database of AIS patients treated surgically, the SSRBA developed has the ability to propose a surgical plan with respect to approach and levels of fusion that match the surgeon's plan in a great majority of cases. Since this SSRBA seems to output multiple valid surgical strategies, it could allow the comparisons of various strategies and the outcomes achieved in similar cases in large databases for a given case and guide surgical treatment.

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Spine slenderness and wedging in adolescent idiopathic scoliosis and in asymptomatic population: an observational retrospective study

Vergari

Karam²,

Pietton³

et al. 2020

Eur Spine J

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Purpose The origin of the deformity due to adolescent idiopathic scoliosis (AIS) is not known, but mechanical instability of the spine could be involved in its progression. Spine slenderness (the ratio of vertebral height to transversal size) could facilitate this instability, thus playing a role in scoliosis progression. The purpose of this work was to investigate slenderness and wedging of vertebrae and intervertebral discs in AIS patients, relative to their curve topology and to the morphology of control subjects. Methods A total of 321 AIS patients (272 girls, 14 ± 2 years old, median Risser sign 3, Cobb angle 35° ± 18°) and 83 controls were retrospectively included (56 girls, median Risser 2, 14 ± 3 years). Standing biplanar radiography and 3D reconstruction of the spine were performed. Geometrical features were computed: spinal length, vertebral and disc sizes, slenderness ratio, frontal and sagittal wedging angles. Measurement reproducibility was evaluated. Results AIS girls before 11 years of age had slightly longer spines than controls (p = 0.04, Mann-Whitney test). AIS vertebrae were significantly more slender than controls at almost all levels, almost independently of topology. Frontal wedging of apical vertebrae was higher in AIS, as expected, but also lower junctional discs showed higher wedging than controls. Conclusion AIS patients showed more slender spines than the asymptomatic population. Analysis of wedging suggests that lower junctional discs and apex vertebra could be locations of mechanical instability. Numerical simulation and longitudinal clinical follow-up of patients could clarify the impact of wedging, slenderness and growth on the biomechanics of scoliosis progression.

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Choosing Fusion Levels in Adolescent Idiopathic Scoliosis

Cited by 26 publications

References 36 publications

Do Current Recommendations for Upper Instrumented Vertebra Predict Shoulder Imbalance? An Attempted Validation of Level Selection for Adolescent Idiopathic Scoliosis

Do Current Recommendations for Upper Instrumented Vertebra Predict Shoulder Imbalance? An Attempted Validation of Level Selection for Adolescent Idiopathic Scoliosis

A rule-based algorithm can output valid surgical strategies in the treatment of AIS

Spine slenderness and wedging in adolescent idiopathic scoliosis and in asymptomatic population: an observational retrospective study

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