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Influence of the thoracolumbar junction flexibility on the risk of adding-on after posterior vertebral arthrodesis for thoracic idiopathic adolescent scoliosis

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Abstract

Purpose

The objective was to analyze the role of the thoracolumbar sagittal flexibility on the outcome after posterior spinal fusion of Lenke 1 and 2 adolescent idiopathic scoliosis with last touched vertebra as the lowest instrumented vertebra.

Methods

We included 105 thoracic AIS patients who had a posterior spinal fusion with a 2 years minimum follow-up. Thoracolumbar junction flexibility was assessed on dynamic sagittal X-rays and compared to the standing position. Adding-on was defined according to radiographic Wang criteria. The junction was considered flexible if the variability from the static position to flexion and/or extension was greater than 10°.

Results

Mean age of the patients was 14 ± 2 years. The preoperative mean Cobb angle was 61 ± 12.7° and 27.5 ± 7.7° after surgery. Mean follow-up was 3.1 years. Twenty-nine patients (28%) developed an adding-on. Thoracolumbar junction range of motion was higher (p = 0.017) with higher flexibility in flexion (p < 0.001) in the no adding-on group. In no adding-on group, 53 patients (70%) had a flexible thoracolumbar junction, and 23 patients (30%) had a stiff thoracolumbar junction in flexion and flexible in extension. In adding-on group, 27 patients (93%) had a stiff thoracolumbar junction, and 2 patients (7%) had a flexible junction in flexion and stiff in extension.

Conclusion

The flexibility of the thoracolumbar junction is a determining factor in the surgical outcome after posterior spinal fusion for AIS and should be considered in correlation with the frontal and sagittal alignment of the spine.

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Authors and Affiliations

  1. Orthopedic Surgery Department, Gatien de Clocheville Children’s Hospital, Beranger Boulevard 49, 37044, Tours, France

    Emilie Andre, Benoit De Courtivron, François Bergerault & Thierry Odent

  2. Orthopedic Surgery Department, Centre des Massues, Croix Rouge Française, Lyon, France

    Kariman Abelin-Genevois

Authors
  1. Emilie Andre
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  2. Benoit De Courtivron
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  3. François Bergerault
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  4. Kariman Abelin-Genevois
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Correspondence to Emilie Andre.

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Andre, E., De Courtivron, B., Bergerault, F. et al. Influence of the thoracolumbar junction flexibility on the risk of adding-on after posterior vertebral arthrodesis for thoracic idiopathic adolescent scoliosis. Eur Spine J 32, 2574–2579 (2023). https://doi.org/10.1007/s00586-023-07763-9

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  • DOI: https://doi.org/10.1007/s00586-023-07763-9

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