Skip to main content
SpringerLink
Log in

Thoracolumbar Scoliosis (AIS) Posterior Surgery Complication

  • Chapter
  • First Online:
Spinal Deformity

  • 995 Accesses

Abstract

The distal adding-on phenomenon is a known complication after surgical treatment of adolescent idiopathic scoliosis (AIS) that can lead to loss of deformity correction, worsening pain, wedging, and degeneration of the adjacent intervertebral disc, as well as the need for revision surgery. Various factors have been associated with the adding-on phenomenon including age, skeletal maturity, direction of the L4 disc tilt, postoperative shoulder imbalance, and, perhaps most importantly, the selection of the lowest instrumented vertebra (LIV). This chapter provides a case illustration of the adding-on phenomenon along with discussion of various risk factors and a review of pertinent literature. Spinal deformity surgeons must recognize these risk factors for adding-on and choose the LIV carefully to optimize clinical outcomes and avoid the need for revision surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. Cho RH, Yaszay B, Bartley CE, Bastrom TP, Newton PO. Which Lenke 1A curves are at the greatest risk for adding-on... And why? Spine. 2012;37(16):1384–90.

    Article  PubMed  Google Scholar 

  2. Lehman RA, Lenke LG, Keeler KA, Kim YJ, Buchowski JM, Cheh G, et al. Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of one hundred fourteen cases. Spine. 2008;33(14):1598–604.

    Article  PubMed  Google Scholar 

  3. Wang Y, Hansen ES, Høy K, Wu C, Bünger CE. Distal adding-on phenomenon in Lenke 1A scoliosis: risk factor identification and treatment strategy comparison. Spine. 2011;36(14):1113–22.

    Article  PubMed  Google Scholar 

  4. Lakhal W, Loret J-E, de Bodman C, Fournier J, Bergerault F, de Courtivron B, et al. The progression of lumbar curves in adolescent Lenke 1 scoliosis and the distal adding-on phenomenon. Orthop Traumatol Surg Res. 2014;100(4):S249–54.

    Article  CAS  PubMed  Google Scholar 

  5. Cao K, Watanabe K, Kawakami N, Tsuji T, Hosogane N, Yonezawa I, et al. Selection of lower instrumented vertebra in treating Lenke type 2A adolescent idiopathic scoliosis. Spine. 2014;39(4):E253–61.

    Article  PubMed  Google Scholar 

  6. Matsumoto M, Watanabe K, Hosogane N, Kawakami N, Tsuji T, Uno K, et al. Postoperative distal adding-on and related factors in Lenke type 1A curve. Spine. 2013;38(9):737–44.

    Article  PubMed  Google Scholar 

  7. Zang L, Hai Y, Yuan S, Su Q, Yang J, Guan L, et al. Distal adding-on and risk factors in severe and rigid scoliosis. Spine. 2016;42(3):160–8.

    Article  Google Scholar 

  8. Qin X, Sun W, Xu L, Liu Z, Qiu Y, Zhu Z. Selecting the last “substantially” touching vertebra as lowest instrumented vertebra in Lenke type 1A curve: radiographic outcomes with a minimum of 2-year follow-up. Spine. 2016;41(12):E742–50.

    Article  PubMed  Google Scholar 

  9. Yang C, Li Y, Yang M, Zhao Y, Zhu X, Li M, et al. Adding-on phenomenon after surgery in Lenke type 1, 2 adolescent idiopathic scoliosis: is it predictable? Spine. 2016;41(8):698–704.

    Article  PubMed  Google Scholar 

  10. Nohara A, Kawakami N, Saito T, Tsuji T, Ohara T, Suzuki Y, et al. Comparison of surgical outcomes between anterior fusion and posterior fusion in patients with AIS Lenke type 1 or 2 that underwent selective thoracic fusion-long-term follow-up study longer than 10 postoperative years. Spine. 2015;40(21):1681–9.

    Article  PubMed  Google Scholar 

  11. Murphy JS, Upasani VV, Yaszay B, Bastrom TP, Bartley CE, Samdani A, et al. Predictors of distal adding-on in thoracic major curves with AR lumbar modifiers. Spine. 2016;42(4):E211–8.

    Article  Google Scholar 

  12. Suk S-I, Lee S-M, Chung E-R, Kim J-H, Kim W-J, Sohn H-M. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine. 2003;28(5):484–91.

    PubMed  Google Scholar 

  13. Wang Y, Bünger CE, Zhang Y, Wu C, Li H, Hansen ES. Distal adding-on in Lenke 1A scoliosis: how to more effectively determine the onset of distal adding-on. Spine. 2013;38(6):490–5.

    Article  PubMed  Google Scholar 

  14. King HA, Moe JH, Bradford DS, Winter RB. The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am. 1983;65(9):1302–13.

    Article  CAS  PubMed  Google Scholar 

  15. Potter BK, Rosner MK, Lehman RA, Polly DW, Schroeder TM, Kuklo TR. Reliability of end, neutral, and stable vertebrae identification in adolescent idiopathic scoliosis. Spine. 2005;30(14):1658–63.

    Article  PubMed  Google Scholar 

  16. Cho K-J, Lenke LG, Bridwell KH, Kamiya M, Sides B. Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis: the sagittal stable vertebra concept. Spine. 2009;34(8):765–70.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, Cathay General Hospital, 280 Renai Rd. Sec.4, Taipei, 106, Taiwan

    Chewei Liu

  2. The Spine Hospital, Columbia University Medical Center, 808 Columbus Ave. #20F, New York, NY, 10025, USA

    Lee A. Tan

  3. Department of Orthopedics, The Spine Hospital, New York Presbyterian/Allen, 5141 Broadway, 3FW-22, New York, NY, 10034, USA

    Kathy M. Blanke & Lawrence G. Lenke

Authors
  1. Chewei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lee A. Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathy M. Blanke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lawrence G. Lenke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lawrence G. Lenke .

Editor information

Editors and Affiliations

  1. Joan O’Reilly Endowed Professor in Spinal Surgery, Vice Chairman, Department of Neurosurgery, University of California, San Francisco, California, USA

    Praveen V. Mummaneni

  2. Professor, Director of Spinal Surgery, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA

    Paul Park

  3. University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Charles H. Crawford III

  4. Chief, Division of Spine Surgery, Associate Professor of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Adam S. Kanter

  5. Department of Orthopedic Surgery, University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Steven D. Glassman

Rights and permissions

Reprints and permissions

Copyright information

© 2018 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Liu, C., Tan, L.A., Blanke, K.M., Lenke, L.G. (2018). Thoracolumbar Scoliosis (AIS) Posterior Surgery Complication. In: Mummaneni, P., Park, P., Crawford III, C., Kanter, A., Glassman, S. (eds) Spinal Deformity . Springer, Cham. https://doi.org/10.1007/978-3-319-60083-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60083-3_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60082-6

  • Online ISBN: 978-3-319-60083-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation