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Optimizing the fusion level for lenke 5C adolescent idiopathic scoliosis: is the S-line a validated and reproducible tool to predict coronal decompensation?

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Abstract

Purpose

To validate the predictability of S-line in Lenke 5C patients.

Methods

Lenke 5C patients with a minimum 2-year follow-up and with the lowest instrumented vertebra (LIV) at lower end vertebra were included. The S-line was defined as a line connecting the centers of concave-side pedicles of upper instrumented vertebra (UIV) and LIV on baseline films. The S-line tilt to right was defined as positive S-line status (S-line +) and tilt to left as S-line − status. Statistical analysis was performed between different subgroups.

Results

Among the 92 patients, 69 patients had a left lumbar curve and 23 patients had a right lumbar curve. For left curves, the S-line + status had a significantly higher incidence of both proximal and distal decompensation. However, for right curves, the S-line − status was the risk factor. Thus, we modified the definition of S-line: The value of S-line tilt for right curves was opposite to that for left curves. Patients with modified S-line + showed a significantly higher incidence of both proximal and distal decompensation in Lenke 5C patients with both left and right curves (p < 0.001 and p = 0.010). In UEV group, patients with modified S-line + showed significantly higher incidence of proximal decompensation (P = 0.001). However, in UEV-1 group, the incidence of proximal decompensation was not statistically affected by modified S-line + (P = 0.281).

Conclusion

Modified S-line + is a validated risk factor that predisposed to post-operative coronal decompensation in Lenke 5C AIS patients. Selecting UIV at one level caudal to UEV could be a possible solution if the modified S-line was positive.

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Funding

This work was financially supported by the Natural Science Foundation of Jiangsu Province (No. BK20180122); and supported by the Special Funds for Health Science and Technology Development of Nanjing City (No. YKK18092).

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Authors and Affiliations

  1. Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China

    Tianyuan Zhang, Shibin Shu, Wenting Jing, Zezhang Zhu, Zhen Liu, Yong Qiu, Xu Sun, Bin Wang & Hongda Bao

  2. Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China

    Qi Gu

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  1. Tianyuan Zhang
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Correspondence to Hongda Bao.

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Zhang, T., Shu, S., Jing, W. et al. Optimizing the fusion level for lenke 5C adolescent idiopathic scoliosis: is the S-line a validated and reproducible tool to predict coronal decompensation?. Eur Spine J 30, 1935–1942 (2021). https://doi.org/10.1007/s00586-021-06781-9

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