Distal adding-on phenomenon in adolescent idiopathic scoliosis patients with thoracolumbar vertebra fusion

Xu, Wei; Chen, Chao; Li, Yifan; Yang, Chen; Li, Ming; Li, Zhikun; Zhu, Xiaodong

doi:10.1097/md.0000000000008099

Cited by 9 publications

(3 citation statements)

References 27 publications

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“… 30 Xu et al classified the positional relationship between LIV and CSVL (Touch classification), which was categorized into A, the CSVL was located lateral to LIV pedicle; B, the CSVL touched the LIV pedicle; and C, the CSVL was located between both LIV pedicles. 31 The authors found that 58% of patients with Touch type A and 12% type B had adding-on phenomenon, while no adding-on was found in type C patients. As these factors were well proven, this study was designed specifically to analyze the predictive factors for distal adding-on in non-AR curve patients with selected LIV at the STV and located at L1 or more proximal.…”

Section: Discussionmentioning

confidence: 94%

Preoperative “Cervical Axis” Deviation Increases the Risk of Distal Adding-On Following Surgery in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients

Chan

Ch’ng

Lee

et al. 2021

Global Spine Journal

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Study Design: Retrospective. Purpose: To evaluate the relationship between shoulder/ neck imbalance with distal adding-on phenomenon and to identify other risk factors in Lenke 1 and 2 (non-AR curves) adolescent idiopathic scoliosis (AIS) patients. Methods: 100 Lenke 1 and 2 AIS patients with lowest instrumented vertebra (LIV) cephalad to or at L1 were recruited. Medial shoulder/ neck balance was represented by T1-tilt and cervical axis (CA). Lateral shoulder balance was represented by clavicle angle (Cla-A) and radiographic shoulder height (RSH). Distal adding-on phenomenon was diagnosed when there was disc wedging below LIV of >5o at final follow-up. Predictive factors and odds ratio were derived using univariate and multivariate logistic regression analysis. Results: Mean age of this cohort was 15.9 ± 4.4 years. Mean follow-up duration was 30.9 ± 9.6 months. Distal adding-on phenomenon occurred in 19 patients (19.0%). Only Risser grade, preoperative CA and final follow-up lumbar Cobb angle were the independent factors. A positive preoperative CA deviation increased the odds of distal adding-on by 5.4 times (95% CI 1.34-21.51, P = 0.018). The mean immediate postoperative T1-tilt, CA, RSH and Cla-A were comparable between the group with distal adding-on and the group without. Conclusion: Distal adding-on phenomenon occurred in 19.0% of patients. Preoperative “Cervical Axis” was an important factor and it increased the risk of distal adding-on by 5.4 times. Other significant predictive factors were Risser grade and lumbar Cobb angle at final follow-up. Immediate postoperative shoulder or neck imbalance was not a significant factor for postoperative distal adding-on phenomenon.

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Section: Discussionmentioning

confidence: 94%

Preoperative “Cervical Axis” Deviation Increases the Risk of Distal Adding-On Following Surgery in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients

Chan

Ch’ng

Lee

et al. 2021

Global Spine Journal

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“…25 The selection of LIV highly correlated with AO and the incidence increased as the LIV selection moved proximally. 26 The other reasons for AO suggested were over correction of main thoracic curve. 27 Anticipation of AO phenomenon was one of the main arguments by the surgeons group who chose distal LIV(SV) in preference to proximal LIV(TV).Wang et al studied 10 different factors that may be responsible for AO and found LIV selection and immaturity as the only factors which highly correlated with AO.…”

Section: Discussionmentioning

confidence: 99%

Is it Safe to Save Levels and Choose the Lowest Instrumented Vertebra as Touched Vertebra While Selectively Fusing Lenke 1/2 Curves? A Proportional Meta-Analysis of Existing Evidence

Ifthekar

Ahuja

Sudhakar

et al. 2022

Global Spine Journal

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Study design Meta-analysis. Objective To compare the clinical and radiological outcomes in patients with Adolescent Idiopathic scoliosis (AIS) treated by selective thoracic fusion (STF) with lowest instrumented vertebra (LIV) at touched vertebra (TV) vs stable vertebra (SV). Methods The databases PubMed, Embase and Google Scholar were searched until November 2020.Studies which had Lenke type 1 curves and Lenke type 2 curves in adolescent population treated by STF and which reported pre- and post-operative curve characteristics including correction percentage and complications were included. Studies which did not report the LIV selection, curve correction percentages and whose full text could not be acquired were excluded. Results Eight studies were included for analysis of which seven were found to be retrospective studies (level III evidence) and one was prospective study (level II evidence) each. Overall proportional meta-analysis found no significant difference in correction rate, total srs-22 scores, and complication rates. Conclusion The evaluation of SV group and TV group as LIV for selective thoracic fusions in AIS reveals a comparable outcome in terms of curve correction, patient satisfaction scores and complication rates. The TV can be chosen safely as the LIV especially in type A and B Lenke 1&2 curves, as it saves more motion segments when compared to SV.

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“…The touch type represents the relationship between the lumbar vertebra and the center sacrum vertical line (CSVL). [20] Type A is touch without pedicle (beside the vertebra), type B is touch with pedicle, and type C is the CSVL in the middle of the pedicles. Touch type is similar to the lumbar modifier of Lenke classification [5] ; however, touch type places more emphasis on the position relationship between the CSVL and pedicle, especially the pedicle of the first vertebra, which the CSVL touches from the sacrum to the thoracic vertebra.…”

Section: Methodsmentioning

confidence: 99%

The radiographic parameter risk factors of rapid curve progression in Lenke 5 and 6 adolescent idiopathic scoliosis

Chen

et al. 2017

Medicine

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Various parameters related to growth and maturity have been shown to be risk factors for scoliosis curve progression. We previously identified correlations between curve progression and radiographic parameters in clinical practice, but there is a lack of research.The aim of this study was to investigate and identify the radiographic parameters that are risk factors for rapid curve progression in Lenke 5 or 6 adolescent idiopathic scoliosis (AIS).A retrospective review of patients who were prospectively enrolled at the initiation of brace wear and followed through completion of bracing or surgery was performed. The inclusion criteria were as follows: a Lenke type 5 or 6 classification, Risser sign grade 0 or 1 at the initial outpatient examination, a follow-up period of 6 months including a minimum of 4 follow-ups, At each visit, the whole spine x-ray was completed, the following data were measured and collected: angle of the lumbar curve (LC), rotation of the apical vertebra (RAV) in the LC, deviation of the apical vertebra (DAV) in the lumbar curve, clavicle angle, L5 tilt angle (TA), body mass index, flexibility of the LC (FLC), and peak angle velocity (PAV). A binary logistic regression analysis was used to assess the contribution of each variable to PAV onset. The touch types for the determination of the lowest instrumented vertebra (LIV) were compared at both the PAV and final follow-up.Thirty-six AIS patients were recruited. The binary logistic regression model indicated that the following variable values significantly contributed to a high risk of PAV occurrence: LC ≥30° (OR = 6.153, 95%CI = 1.683-22.488, P = .006), RAV ≥III (OR = 15.484, 95%CI = 4.535-52.865, P <.001), DAV ≥40 mm (OR = 8.599, 95%CI = 2.483-29.784, P <.001), and TA ≥10° (OR = 2.223, 95%CI = 3.094-27.563, P <.001). The touch types for LIV determination changed in 12 of 36 patients, with at least 1 segment added as the LIV between the PAV and the final visit.LC ≥30°, RAV ≥III, DAV ≥40 mm, and L5 TA≥10° were radiographic parameters associated with an increased risk of curve progression in Lenke 5 and 6 AIS. The orthopedic surgery performed at the PAV is the ideal timing, and it will preserve 1 active segment than later surgery.Level of evidence was 4.

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Distal adding-on phenomenon in adolescent idiopathic scoliosis patients with thoracolumbar vertebra fusion

Cited by 9 publications

References 27 publications

Preoperative “Cervical Axis” Deviation Increases the Risk of Distal Adding-On Following Surgery in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients

Preoperative “Cervical Axis” Deviation Increases the Risk of Distal Adding-On Following Surgery in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients

Is it Safe to Save Levels and Choose the Lowest Instrumented Vertebra as Touched Vertebra While Selectively Fusing Lenke 1/2 Curves? A Proportional Meta-Analysis of Existing Evidence

The radiographic parameter risk factors of rapid curve progression in Lenke 5 and 6 adolescent idiopathic scoliosis

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