Disc Degeneration in Unfused Caudal Motion Segments Ten Years Following Surgery for Adolescent Idiopathic Scoliosis

Lonner, Baron S.; Ren, Yuan; Upasani, Vidyadhar V.; Marks, Michelle; Newton, Peter O.; Samdani, Amer F.; Shufflebarger, Harry L.; Shah, Suken A.; Lefton, Daniel R.; Nasser, Hussein; Dabrowski, Colin T.; Betz, Randal R.

doi:10.1016/j.jspd.2018.03.013

Cited by 45 publications

(32 citation statements)

References 29 publications

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“…There has been only one report investigating LIV tilt and other radiographic measurements with SRS-22 outcomes. 15 Although there was no significant association between the 10-year composite radiographic score and SRS-22 scores, disc wedging subjacent to the LIV (≥ 5°) led to significant disc degeneration below the LIV. 15 For longer periods, this disc degeneration may affect the patient reported outcomes.…”

Section: Discussionmentioning

confidence: 84%

“…15 Although there was no significant association between the 10-year composite radiographic score and SRS-22 scores, disc wedging subjacent to the LIV (≥ 5°) led to significant disc degeneration below the LIV. 15 For longer periods, this disc degeneration may affect the patient reported outcomes. Although the follow-up period of this study was only 2 years, coronal balance was reported to be stable over 20 years if the uninstrumented lumbar curve was corrected to < 35°.…”

Section: Discussionmentioning

confidence: 84%

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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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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 84%

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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“…Accordingly, extending spinal fusion distally may be effective to reduce a residual lumbar curve, such as for spontaneous lumbar curve correction of a Lenke type 1 curve. 16 However, because it is advisable to preserve as many caudal motion segments as possible to decrease the risk of disc degeneration 17 and enable a return to athletic activity, 18,19 distal fusion extension for better self-image is not a pragmatic option. Instead, patients should be informed of the possibility of lumbar curvature after surgery to help them accept any residual deformity.…”

Section: Discussionmentioning

confidence: 99%

Residual thoracolumbar/lumbar curve is related to self-image after posterior spinal fusion for Lenke 1 and 2 curves in adolescent idiopathic scoliosis patients

Mimura

Ikegami

Kuraishi

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAlthough it is well known that major curve severity in adolescent idiopathic scoliosis (AIS) is inversely related to self-image, surgeons often encounter patients who complain of low self-image with preoperatively mild curves or postoperatively well-corrected main curves, suggesting the presence of other factors. This study examined factors contributing to self-image in AIS.METHODSA total of 86 consecutive patients who underwent posterior spinal fusion for AIS Lenke 1 or 2 curves and were followed for a minimum of 2 years were included in this study of patient self-image based on data that included scores reported on the Scoliosis Research Society survey (SRS-22r). The authors evaluated sex, BMI, Risser grade, age, angle of trunk rotation, Cobb angle of the main thoracic (MT) curve, Cobb angle of the thoracolumbar/lumbar (TL/L) curve, apical vertebral translation (AVT), T5–12 kyphotic angle, and clavicular angle. Univariate and multivariate general linear models were employed to identify preoperative and 2-year postoperative factors that impact self-image.RESULTSUnivariate analysis revealed no significant correlation between preoperative MT curve Cobb angle and SRS-22r self-image score (p = 0.51), although patients with a higher MT curve AVT had a significantly worse preoperative self-image (p < 0.01). Two years postoperatively, larger Cobb angle of the TL/L curve (p = 0.01) and higher Risser grade (p = 0.03) resulted in significantly lower self-image scores. In multivariate testing, preoperative MT curve AVT remained significantly related to diminished self-image (p < 0.01). Two years later, higher TL/L curve (p < 0.01), Risser grade (p = 0.03), and MT curve AVT (p = 0.03) had significant associations with lower self-image scores.CONCLUSIONSPreoperative MT curve AVT appears more strongly related to self-image than does Cobb angle. Two years postoperatively, persistent TL/L region curvature and high Risser grade may also be associated with diminished patient self-image.

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“…This is especially valid for mobility in the lumbar segments. It may be accepted that the stress in a few residual mobile segments is higher and that this will result in an increased rate of degenerative disc disease during a lifetime (37).…”

Section: Fusion Lengthmentioning

confidence: 99%

Anterior instrumented fusion for adolescent idiopathic scoliosis

Ruf¹,

Drumm²,

Jeszenszky³

2020

Ann Transl Med

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Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine consisting of a lateral curvature, apical vertebral rotation, and an impairment of the sagittal profile. Surgical options include anterior and posterior approaches. Anterior instrumented fusion is suitable in Lenke type 1 and 5 curves. It supplies excellent results in coronal plane correction and is superior in the restoration of the sagittal profile and apical derotation. Fusion is shorter compared to posterior correction, and the complication rate is low. Pulmonary function is impaired postoperatively but recovers within a few years.

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Disc Degeneration in Unfused Caudal Motion Segments Ten Years Following Surgery for Adolescent Idiopathic Scoliosis

Cited by 45 publications

References 29 publications

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

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

Residual thoracolumbar/lumbar curve is related to self-image after posterior spinal fusion for Lenke 1 and 2 curves in adolescent idiopathic scoliosis patients

Anterior instrumented fusion for adolescent idiopathic scoliosis

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