What Is the Best Distal Level of Arthrodesis in Lumbar Fusion in Patients With Adolescent Idiopathic Scoliosis: L3 or L4?

Abstract

Objective To evaluate coronal alignment in patients with idiopathic adolescent scoliosis with structured lumbar curves submitted to surgical treatment by comparing coronal alignment in the group fusion up to L3 and the group fusion up to L4. Methods Retrospective cohort study. We evaluated patients submitted to surgical treatment with arthrodesis of the lumbar curve with high density of screws with at least 6 months of follow-up. Radiographically, coronal alignment, shoulder height and functional outcome were analyzed through SRS30 questionnaire. Results A total of 25 patients were analyzed, of which 23 were female and 2 were male, with a mean age of 15.2 years (12 to 29 years) at the time of surgery. The patients were divided into two groups. Group A, n = 15: Distal level of fusion in L3 and Group B, n = 10: distal level of fusion in L4. There was no statistically significant difference between Groups A and B when compared to coronal alignment (balanced vs. unbalanced). However, when compared with the coronal alignment (CA) values, lower values of CA were observed in Group A, with statistical significance. No difference was observed between Groups A and B with respect to the SRS30 questionnaire. Conclusions Patients with idiopathic adolescent scoliosis submitted to arthrodesis of the lumbar curve have a better coronal alignment when the distal fusion level is L3. Level of evidence III; Comparative Retrospective Study (based on prospectively collected data).

Evaluating Lumbar Intervertebral Disc Degeneration on a Compositional Level Using Chemical Exchange Saturation Transfer: Preliminary Results in Patients with Adolescent Idiopathic Scoliosis

“…As these changes may progress further with increasing age [ 21 ], thereby underscoring the clinical need to diagnose early degeneration, timely diagnosis is a prerequisite for timely treatment. In severe cases of scoliotic deformity, with a Cobb angle of over 50°, spinal fusion surgery remains the treatment of choice in AIS patients [ 8 , 9 ] after skeletal maturity. As of today, it is still controversially discussed whether spinal fusion in the lower lumbar segments leads to the development of premature disc degeneration and subsequent back pain in AIS patients by reducing the number of mobile segments or if the disease itself might be the cause due to mechanical stress of the spinal curvature [ 30 , 31 ].…”

“…Presently, selective fusion [7] is performed by sparing fusion of minor curves, i.e., less affected spinal segments. Short segment fusion leads to less frequent IVD degeneration and pain [8,9]. However, only little is known about preoperative IVD degeneration in patients with AIS [10].…”

Selection of Fusion Level for Adolescent Idiopathic Scoliosis Surgery : Selective Fusion versus Postoperative Decompensation

“…However, if LEV ≤ L4 and LTV = L5, caution is required in selecting the distal fusion level. Recent studies of TL/L AIS also documented that stopping fusion at L3 or preserving 1 or 2 mobile segments showed similar clinical and radiological outcomes to those obtained with longer fusions [ 7 , 20 ]. The results of studies on LIV selection in AIS with TL/L curves are summarized in Table 6 .…”