Distal Adding-On Phenomenon in Lenke 1A Scoliosis

Wang, Yu; Hansen, Ebbe Stender; Høy, Kristian; Wu, Chunsen; Bünger, Cody

doi:10.1097/brs.0b013e3181f51e95

Cited by 123 publications

(59 citation statements)

References 3 publications

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“…Distal adding-on is a common complication in AIS patients with a prevalence ranging from 12.9% to 51.1% [6, 8–11, 18, 19]. Adding-on may have adverse effects on the lumbar spine in the long term or even require revision surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were recruited into this study with the following criteria: (1) age from 11 to 18 years; (2) Lenke type 1A or 2A; (3) distal adding-on occurring during the follow-up; (4) follow-up more than 2 years. Primary distal adding-on was defined as an increase in the number of vertebrae included within the distal curve from the first erect radiograph to the follow-up radiograph, with (1) an increase of more than 5 mm in the deviation of the first vertebra below the instrumentation from the CSVL or (2) an increase of more than 5° in the angulation of the first disc below the instrumentation [6]. Among the 284 patients reviewed, 61 (21.5%) with primary distal adding-on occurrence during follow-up were included in the study.…”

Section: Methodsmentioning

confidence: 99%

“…However, some patients may have postoperative coronal decompensation although lumbar curves can improve spontaneously after selective thoracic fusion. Of particular concern is the “adding-on” phenomenon caudal to the fusion, defined as an increase in the number of vertebrae within the distal curve from the first erect radiograph postoperatively to the last follow-up [6]. Distal adding-on could lead to increased coronal decompensation and disc wedging, which in turn could result in degenerative changes later in life and further surgical intervention [7].…”

Section: Introductionmentioning

confidence: 99%

“…Risk factors associated with adding-on have been well documented in previous studies, such as lowest instrumented vertebra (LIV) selection, apical translation, and skeletal maturity [6–10]. Among them, the inappropriate selection of LIV seems to be the major cause [6, 8–10].…”

Section: Introductionmentioning

confidence: 99%

“…Among them, the inappropriate selection of LIV seems to be the major cause [6, 8–10]. In previous literature, nearly 6-7% of AIS patients with adding-on need revision surgery for progressive adding-on [10, 11].…”

Section: Introductionmentioning

confidence: 99%

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Natural History of Postoperative Adding-On in Adolescent Idiopathic Scoliosis: What Are the Risk Factors for Progressive Adding-On?

Qin

Xia

et al. 2018

BioMed Research International

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Purpose To investigate the natural history of distal adding-on in adolescent idiopathic scoliosis (AIS) and to identify risk factors for its progression. Methods Sixty-one AIS patients with distal adding-on occurrence were included. We further classify distal adding-on into progressive and nonprogressive group according to its natural evolution. The first radiograph indicating initiation of adding-on (primary adding-on) and the last follow-up radiograph were compared in terms of the deviation of the first vertebra below instrumentation from the CSVL and the angulation of the first disc below instrumentation. Compared to primary adding-on, progressive adding-on was defined as a further increase of deviation > 5 mm or a further increase of angulation > 5°. Risk factors associated with the progression of adding-on were analyzed. Results Among 61 patients diagnosed with distal adding-on, 24 (39.3%) were progressive and 37 (60.7%) were nonprogressive. Lower Risser grade, open triradiate cartilage, and lowest instrumented vertebra (LIV) proximal to Substantially Stable Vertebra (SSV) were found to be significantly associated with the progressive adding-on. Besides, the distal adding-on was more likely to progress for patients with higher left shoulders than right ones after surgery. Conclusions The risk factors for the progression of adding-on included skeletal immaturity, LIV proximal to SSV, and higher left shoulders after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Natural History of Postoperative Adding-On in Adolescent Idiopathic Scoliosis: What Are the Risk Factors for Progressive Adding-On?

Qin

Xia

et al. 2018

BioMed Research International

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Thoracolumbar Scoliosis (AIS) Posterior Surgery Complication

et al. 2017

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Extensive fusion for Lenke 3C and 6C scoliosis: a two year radiographic follow-up

Wang

Bünger

Zhang

et al. 2011

International Orthopaedics (SICOT)

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Purpose To investigate the correction effectiveness, incidence rate of distal adding on, and post-operative spinal balance in Lenke 3C and 6C AIS treated with extensive fusion using posterior pedicle screw-only constructs. Methods We reviewed all AIS cases surgically treated in our institution between 2002 and 2008. The inclusion criteria were as follows: (1) Lenke 3C or 6C scoliosis patients who were treated with extensive fusion using posterior pedicle screw-only constructs; (2) minimum two year radiographic follow-up; (3) the lowest instrumented vertebra (LIV) ended at L2, L3 or L4 level. All image data were available in our picture archiving and communication systems (PACSs) , and all radiographic measurements were performed. Standing anteroposterior (AP) and lateral digital radiographs were reviewed at four different time points (pre-op, post-op, three months, and two years). In each standing AP radiograph, CSVL (center sacral vertical line, the vertical line bisecting the proximal sacrum) was first drawn, followed by measurement of the translation (deviation from the CSVL) of some key vertebrae, such as the lowest instrumented vertebra (LIV), LIV+1 (the first vertebra below LIV), lumbar apical vertebra, thoracic apical vertebra and T1, enabling depiction of how translation of different parts of the spine changes over time. Additionally, the Cobb angles of major thoracic and lumbar curves were measured at the different time points and the correction rate was calculated. Results Of the 278 patients reviewed, 25 met the inclusion criteria. Immediately after surgery, satisfactory corrections were achieved from the perspective of not only Cobb angle but also vertebral translation. And the corrections were well retained in the following two years. The incidence rate of distal adding-on was low in this group of patients. In the course of two years following surgery, only six patients had an increase of greater than 5 mm in LIV+1 translation, and among which only two patients had greater than 10 mm. Regarding global balance, overall, it neither improved nor deteriorated after extensive fusion. Furthermore, trunk shift was found in only three patients at two year follow-up. Conclusions In Lenke 3C and 6C scoliosis, extensive fusion can produce satisfactory corrections from the perspectives of both Cobb angle and vertebral translation and rarely causes significant distal adding-on, global imbalance or trunk shift.

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Distal Adding-On Phenomenon in Lenke 1A Scoliosis

Abstract: C1LMS of 95.5% and C2PS of 92.8% were confirmed to be in good position. None of the screws including the malpositioned caused VA injury, clinically or radiographically. The technique for C1LMS and C2PS fixation appears to be safe and effective.

Cited by 123 publications

References 3 publications

Natural History of Postoperative Adding-On in Adolescent Idiopathic Scoliosis: What Are the Risk Factors for Progressive Adding-On?

Natural History of Postoperative Adding-On in Adolescent Idiopathic Scoliosis: What Are the Risk Factors for Progressive Adding-On?

Thoracolumbar Scoliosis (AIS) Posterior Surgery Complication

Extensive fusion for Lenke 3C and 6C scoliosis: a two year radiographic follow-up

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