Skip to main content
SpringerLink
Log in

Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To investigate which pre- and postoperative radiographic parameters are significantly correlated with the immediate postoperative coronal balance (CB) in Lenke 5C AIS patients, and to identify any radiographic parameter that is correlated with the ultimate CB at a minimum follow-up of 2 years.

Methods

Forty Lenke 5C AIS patients were recruited in the current study. Preoperative, immediate postoperative, and the latest follow-up radiographs were reviewed measuring various radiographic parameters related to UIV and LIV. The correlations between different parameters and CB were then studied.

Results

The average follow-up time was 35.2 months. Correlation analysis showed that the following radiographic parameters significantly associated with the immediate postoperative CB in Lenke 5C patients: preoperative CB (r = 0.66, p < 0.01), preoperative UIV translation (r = 0.61, p < 0.01), preoperative LIV tilt (r = 0.61, p < 0.01), postoperative UIV translation (r = 0.51, p < 0.05), and postoperative LIV tilt (r = 0.50, p < 0.05). At the last follow-up, only the final UIV tilt was inversely correlated with the ultimate CB (r = −0.58, p < 0.05). Seven patients presented with coronal imbalance immediately after surgery. However, only one of the seven patients presented with coronal imbalance at the last follow-up, and the other six achieved C7PL–CSVL distance within 10 mm.

Conclusions

In Lenke 5C patients, preoperative UIV translation and LIV tilt are two important parameters that can predict the immediate postoperative CB. During the postoperative follow-up, UIV tilt may play a very important role in compensating for postoperative coronal imbalance.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Remes V, Helenius I, Schlenzka D, Yrjonen T, Ylikoski M, Poussa M (2004) Cotrel-Dubousset (CD) or Universal Spine System (USS) instrumentation in adolescent idiopathic scoliosis (AIS): comparison of midterm clinical, functional, and radiologic outcomes. Spine (Phila Pa 1976) 29:2024–2030

    Article  Google Scholar 

  2. Suk SI, Lee SM, Chung ER, Kim JH, Kim SS (2005) Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis: more than 5-year follow-up. Spine (Phila Pa 1976) 30:1602–1609

    Article  Google Scholar 

  3. Fischer CR, Kim Y (2011) Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy. Eur Spine J 20:1048–1057

    Article  PubMed  Google Scholar 

  4. Zhao Y, Wang Z, Zhu X, Wang C, He S, Li M (2011) Prediction of postoperative trunk imbalance after posterior spinal fusion with pedicle screw fixation for adolescent idiopathic scoliosis. J Pediatr Orthop B 20:199–208

    Article  PubMed  Google Scholar 

  5. Dobbs MB, Lenke LG, Walton T, Peelle M, Della Rocca G, Steger-May K, Bridwell KH (2004) Can we predict the ultimate lumbar curve in adolescent idiopathic scoliosis patients undergoing a selective fusion with undercorrection of the thoracic curve? Spine (Phila Pa 1976) 29:277–285

    Article  Google Scholar 

  6. Richards BS, Scaduto A, Vanderhave K, Browne R (2005) Assessment of trunk balance in thoracic scoliosis. Spine (Phila Pa 1976) 30:1621–1626

    Article  Google Scholar 

  7. Ni HJ, Su JC, Lu YH, Zhu XD, He SS, Wu DJ, Xu J, Yang CW, Wang CF, Zhao YC, Li M (2011) Using side-bending radiographs to determine the distal fusion level in patients with single thoracic idiopathic scoliosis undergoing posterior correction with pedicle screws. J Spinal Disord Tech 24:437–443

    Article  PubMed  Google Scholar 

  8. Lee CS, Chung SS, Shin SK, Park YS, Park SJ, Kang KC (2011) Changes of upper thoracic curve and shoulder balance in thoracic adolescent idiopathic scoliosis treated by anterior selective thoracic fusion using VATS. J Spinal Disord Tech 24:462–468

    Article  PubMed  Google Scholar 

  9. Li J, Hwang SW, Shi Z, Yan N, Yang C, Wang C, Zhu X, Hou T, Li M (2011) Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5C patients. Spine (Phila Pa 1976) 36:1673–1678

    Article  Google Scholar 

  10. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83-A:1169–1181

    PubMed  CAS  Google Scholar 

  11. Lenke LG, Edwards CC 2nd, Bridwell KH (2003) The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976) 28:S199–S207

    Article  Google Scholar 

  12. Cobb J (1948) Outline for the study of scoliosis. Instr Course Lect 5:261–275

    Google Scholar 

  13. Nash CL Jr, Moe JH (1969) A study of vertebral rotation. J Bone Joint Surg Am 51:223–229

    PubMed  Google Scholar 

  14. Puno RM, An KC, Puno RL, Jacob A, Chung SS (2003) Treatment recommendations for idiopathic scoliosis: an assessment of the Lenke classification. Spine (Phila Pa 1976) 28:2102–2114 (discussion 2114–2105)

    Article  Google Scholar 

  15. Satake K, Lenke LG, Kim YJ, Bridwell KH, Blanke KM, Sides B, Steger-May K (2005) Analysis of the lowest instrumented vertebra following anterior spinal fusion of thoracolumbar/lumbar adolescent idiopathic scoliosis: can we predict postoperative disc wedging? Spine (Phila Pa 1976) 30:418–426

    Article  Google Scholar 

  16. Suk SI, Lee SM, Chung ER, Kim JH, Kim WJ, Sohn HM (2003) Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 28:484–491

    Google Scholar 

  17. Behensky H, Cole AA, Freeman BJ, Grevitt MP, Mehdian HS, Webb JK (2007) Fixed lumbar apical vertebral rotation predicts spinal decompensation in Lenke type 3C adolescent idiopathic scoliosis after selective posterior thoracic correction and fusion. Eur Spine J 16:1570–1578

    Article  PubMed  Google Scholar 

  18. Shufflebarger HL, Geck MJ, Clark CE (2004) The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976) 29:269–276 (discussion 276)

    Article  Google Scholar 

  19. Geck MJ, Rinella A, Hawthorne D, Macagno A, Koester L, Sides B, Bridwell K, Lenke L, Shufflebarger H (2009) Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices. Spine (Phila Pa 1976) 34:1942–1951

    Article  Google Scholar 

Download references

Acknowledgments

This work was supported by the National Public Health Benefit Research Foundation, China (Grant No. 201002018).

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

  1. Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China

    Zhen Liu, Jing Guo, Zezhang Zhu, Bangping Qian, Xu Sun, Leilei Xu & Yong Qiu

Authors
  1. Zhen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jing Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zezhang Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bangping Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xu Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leilei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yong Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Qiu.

Additional information

Z. Liu and J. Guo contributed equally to the study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liu, Z., Guo, J., Zhu, Z. et al. Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion. Eur Spine J 22, 2392–2398 (2013). https://doi.org/10.1007/s00586-013-2808-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-2808-3

Keywords

Search

Navigation