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How to select the lowest instrumented vertebra in Lenke 5/6 adolescent idiopathic scoliosis patients with derotation technique

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Abstract

Purpose

To introduce and evaluate our lowest instrumented vertebra (LIV) selection criteria for Lenke type 5/6 adolescent idiopathic scoliosis (AIS) patients with de-rotation technique.

Methods

There were 53 eligible Lenke 5/6 AIS patients with minimum 2-year follow-up enrolled in current study. The LIV selection criteria were: (1) the first vertebra touching the central sacral vertical line (CSVL) or the most cephalad vertebra which can return to stable zone under lateral bending position; (2) vertebral rotation no more than grade II by Nash–Moe rotation evaluation; (3) the lowest instrumented vertebra disc angle (LIVDA) could be reversed on lateral bending position. Demographic data, operation data and radiographic data were obtained and analyzed.

Results

Both clinical evaluation and radiographic data showed satisfactory outcome. The thoracolumbar/lumbar curve was improved from 53.4 ± 11.0° preoperatively to 6.9 ± 2.6° at the final follow-up. Two patients (3.8%) with adding on and two patients (3.8%) with coronal decompensation were identified at the final follow-up. LIV translation, LIV tilt and LIV disc angle were gradually improved after operation. The preoperative LIV tilt was positively correlated with Cobb angle (p = 0.010) and AVT (p = 0.030) at the final follow-up, and preoperative LIVDA was positively correlated with Cobb angle (p = 0.033) at the final follow-up.

Conclusion

In Lenke 5/6 scoliosis, the current LIV selection criteria with de-rotation technique contribute to satisfactory correction rate of 87.1% and minimal alignment complications of 7.6%. LIV could be spontaneously and progressively improved after operation. Preoperative LIV tilt and LIVDA could predict postoperative correction and coronal balance.

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Acknowledgements

We acknowledge all the participants in this study. In addition, Shao Xiexiang wants to express his special appreciation to Zhou Yu for her endless love, care and encouragement.

Funding

This work was supported by the National Key Research and Development Program (2018YFC0116500), the Key Project of Transformational Medicine Cross-Research Fund of Shanghai Jiaotong University (ZH2018ZDB04).

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Author notes

  1. Xiexiang Shao and Wenyuan Sui contributed equally and shared the first-author status.

Authors and Affiliations

  1. Spine Center, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, People’s Republic of China

    Xiexiang Shao, Wenyuan Sui, Yaolong Deng, Jingfan Yang, Jian Chen & Junlin Yang

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  1. Xiexiang Shao
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  2. Wenyuan Sui
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  3. Yaolong Deng
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  4. Jingfan Yang
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  6. Junlin Yang
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Contributions

X. Shao designed the study, analyzed and interpreted the data, wrote and edited the manuscript. W. Sui collected and analyzed the data, wrote and revised the manuscript. Y. Deng collected and analyzed the data and revised the manuscript. J. Yang analyzed and interpreted the data and revised the manuscript. J. Chen analyzed and interpreted the data. J. Yang designed the study, analyzed and interpreted the data, wrote and edited the manuscript.

Corresponding author

Correspondence to Junlin Yang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Shanghai, China, No.XHEC-D-2021–053).

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Shao, X., Sui, W., Deng, Y. et al. How to select the lowest instrumented vertebra in Lenke 5/6 adolescent idiopathic scoliosis patients with derotation technique. Eur Spine J 31, 996–1005 (2022). https://doi.org/10.1007/s00586-021-07040-7

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