Skip to main content

Advertisement

SpringerLink
Log in

Fusions ending at the thoracolumbar junction in adolescent idiopathic scoliosis: comparison of lower instrumented vertebrae

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

Retrospective cohort study.

Objective

To compare clinical outcomes and radiographic parameters between patients treated with a posterior spinal fusion that had a lower instrumented vertebra at T11, T12, and L1.

Background

Posterior instrumented fusions are well established for treating patients with adolescent idiopathic scoliosis (AIS). Fusions limited to the thoracic spine can adequately correct a spinal deformity while preserving lumbar segmental mobility. However, fusions that end at the thoracolumbar junction have been proposed to cause adjacent segment complications. Studies comparing outcomes between patients who were treated with fusions that end at the thoracolumbar junction with varying LIVs are limited.

Methods

A multicenter database was queried for patients with AIS that had Lenke Type 1 and 2 curves treated with a fusion that had an LIV at T11, T12, or L1. Coronal curve magnitude, degree of junctional kyphosis, C7–central sacral line, thoracic apical translation, and sagittal stable vertebrae were measured. Clinical and functional outcomes were assessed using the Scoliosis Research Society-22 (SRS-22) questionnaire and lumbar flexibility testing.

Results

The lower instrumented level was below the sagittal stable vertebrae in 22.7%, 40%, and 66.2% of patients in the LIV-T11, T12, and L1 groups, respectively (p < 0.001). The 5-year postoperative lumbar curve magnitudes were 20.3°, 16.3°, and 14.0° for T11, T12, and L1-LIV, respectively (p < 0.001). No patients in the T11 group (0%), two patients in the T12 group (2.5%), and one patient in the L1 (0.8%) group developed distal junctional kyphosis (p = 0.5). The 5-year postoperative total SRS-22 scores were 4.21, 4.50, and 4.38 (p = 0.029). Lumbar flexion decreased by 0.78 cm in the T11-LIV group, increased by 0.01 cm in the T12-LIV group, and decreased by 0.15 cm in the L1-LIV group (p = 0.434).

Conclusion

There was no significant difference in SRS-22 scores, development of distal junctional kyphosis or loss of lumbar mobility between patients treated with a spinal fusion that had an LIV at T11, T12, or L1.

Level of evidence

Level III.

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

Similar content being viewed by others

References

  1. Kim YJ, Lenke LG, Cho SK et al (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29:2040–2048

    Article  Google Scholar 

  2. Gomez JA, Matsumoto H, Colacchio ND et al (2014) Risk factors for coronal decompensation after posterior spinal instrumentation and fusion in adolescent idiopathic scoliosis. Spine Deform 2:380–385

    Article  Google Scholar 

  3. Crawford CH 3rd, Carreon LY, Lenke LG et al (2013) Outcomes following posterior fusion for adolescent idiopathic scoliosis with and without autogenous iliac crest bone graft harvesting. Spine Deform 1:144–147

    Article  Google Scholar 

  4. Fan H, Wang Q, Huang Z et al (2016) Comparison of functional outcome and quality of life in patients with idiopathic scoliosis treated by spinal fusion. Medicine (Baltimore) 95:e3289

    Article  Google Scholar 

  5. Wilk B, Karol LA, Johnston CE 2nd et al (2006) The effect of scoliosis fusion on spinal motion: a comparison of fused and nonfused patients with idiopathic scoliosis. Spine (Phila Pa 1976) 31:309–314

    Article  Google Scholar 

  6. Erickson MA, Baulesh DM (2011) Lowest instrumented vertebra selection in AIS. J Pediatr Orthop 31(suppl 1):S69–S76

    Article  Google Scholar 

  7. Qin X, Sun W, Xu L et al (2016) 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 (Phila Pa 1976) 41:E742–E750

    Article  Google Scholar 

  8. Aaro S, Ohlen G (1983) The effect of Harrington instrumentation on the sagittal configuration and mobility of the spine in scoliosis. Spine (Phila Pa 1976) 8:570–575

    Article  CAS  Google Scholar 

  9. Sanchez-Raya J, Bago J, Pellise F et al (2012) Does the lower instrumented vertebra have an effect on lumbar mobility, subjective perception of trunk flexibility, and quality of life in patients with idiopathic scoliosis treated by spinal fusion? J Spinal Disord Tech 25:437–442

    Article  Google Scholar 

  10. Danielsson AJ, Cederlund CG, Ekholm S, Nachemson AL (2001) The prevalence of disc aging and back pain after fusion extending into the lower lumbar spine. A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis. Acta Radiol 42:187–197

    CAS  PubMed  Google Scholar 

  11. Michel CR, Lalain JJ (1985) Late results of Harrington’s operation. Long-term evolution of the lumbar spine below the fused segments. Spine (Phila Pa 1976) 10:414–420

    Article  CAS  Google Scholar 

  12. Takahashi J, Newton PO, Ugrinow VL, Bastrom TP (2011) Selective thoracic fusion in adolescent idiopathic scoliosis: factors influencing the selection of the optimal lowest instrumented vertebra. Spine (Phila Pa 1976) 36:1131–1141

    Article  Google Scholar 

  13. Cho W, Faloon MJ, Essig D et al (2018) Additional risk factors for adding-on after selective thoracic fusion in adolescent idiopathic scoliosis: implication of lowest instrumented vertebra angle and lumbosacral takeoff. Spine Deform 6:164–169

    Article  Google Scholar 

  14. Scaramuzzo L, Giudici F, Bongetta D et al (2017) Thoraco-lumbar selective fusion in adolescent idiopathic scoliosis with Lenke C modifier curves: clinical and radiographic analysis at 10-year follow-up. Eur Spine J 26(suppl 4):514–523

    Article  Google Scholar 

  15. Mizusaki D, Gotfryd AO (2016) Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic in Lenke 1 adolescent idiopathic scoliosis. Rev Bras Ortop 51:83–89

    Article  Google Scholar 

  16. Kim JH, Kim SS, Suk SI (2007) Incidence of proximal adjacent failure in adult lumbar deformity correction based on proximal fusion level. Asian Spine J 1:19–26

    Article  CAS  Google Scholar 

  17. Ha Y, Maruo K, Racine L et al (2013) Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae. J Neurosurg Spine 19:360–369

    Article  Google Scholar 

  18. Hey HWD, Tan KA, Neo CS et al (2017) T9 versus T10 as the upper instrumented vertebra for correction of adult deformity—rationale and recommendations. Spine J 17:615–621

    Article  Google Scholar 

  19. Hostin R, McCarthy I, O’Brien M et al (2013) Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976) 38:1008–1015

    Article  Google Scholar 

  20. Lowe TG, Lenke L, Betz R et al (2006) Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention. Spine (Phila Pa 1976) 31:299–302

    Article  Google Scholar 

  21. Shufflebarger HL, Clark CE (1990) Fusion levels and hook patterns in thoracic scoliosis with Cotrel-Dubousset instrumentation. Spine (Phila Pa 1976) 15:916–920

    Article  CAS  Google Scholar 

  22. Ameri E, Behtash H, Mobini B et al (2011) The prevalence of distal junctional kyphosis following posterior instrumentation and arthrodesis for adolescent idiopathic scoliosis. Acta Med Iran 49:357–363

    PubMed  Google Scholar 

  23. Richards BS, Birch JG, Herring JA et al (1989) Frontal plane and sagittal plane balance following Cotrel-Dubousset instrumentation for idiopathic scoliosis. Spine (Phila Pa 1976) 14:733–737

    Article  CAS  Google Scholar 

  24. Carreon LY, Sanders JO, Diab M et al (2010) The minimum clinically important difference in Scoliosis Research Society-22 appearance, activity, and pain domains after surgical correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:2079–2083

    Article  Google Scholar 

  25. Yang J, Andras LM, Broom AM et al (2018) Preventing distal junctional kyphosis by applying the stable sagittal vertebra concept to selective thoracic fusion in adolescent idiopathic scoliosis. Spine Deform 6:38–42

    Article  Google Scholar 

  26. Palmer ML, Epler ME (1990) Clinical assessment procedures in physical therapy. J. B. Lippincott, Philadelphia

    Google Scholar 

  27. Ding R, Liang J, Qiu G et al (2014) Evaluation of quality of life in adolescent idiopathic scoliosis with different distal fusion level: a comparison of L3 versus L4. J Spinal Disord Tech 27:E155–E161

    Article  Google Scholar 

Download references

Funding

Grants were received from DePuy Synthes Spine to the Setting Scoliosis Straight Foundation in support of Harms Study Group research.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA

    Dale N. Segal, Zachary J. Grabel, Jeffery A. Konopka, Adam R. Boissonneault, Eric Yoon, Tracey P. Bastrom, John M. Flynn & Nicholas D. Fletcher

  2. Department of Orthopedics, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Dale N. Segal, Zachary J. Grabel, Jeffery A. Konopka, Adam R. Boissonneault, Eric Yoon, Tracey P. Bastrom, John M. Flynn & Nicholas D. Fletcher

  3. Department of Orthopaedics, Emory University, 59 Executive Park Dr. S, Atlanta, GA, 30309, USA

    Nicholas D. Fletcher

Authors
  1. Dale N. Segal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zachary J. Grabel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffery A. Konopka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam R. Boissonneault
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tracey P. Bastrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John M. Flynn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nicholas D. Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Harms Study Group

Corresponding author

Correspondence to Nicholas D. Fletcher.

Ethics declarations

Conflict of interest

DNS, ZJG, JAK, ARB, EY, JMF, and Harms Study Group have no conflicts of interest. TPB received grants from Setting Scoliosis Straight Foundation, during the conduct of the study. NDF received grants from Harrison Foundation, personal fees from Zimmer/Biomet, Orthopaediatrics, and Medtronic Spine, outside the submitted work.

IRB statement

IRB approval for the multicenter study was obtained locally from each contributing institution’s review board, and consent was obtained from each patient before data collection.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Segal, D.N., Grabel, Z.J., Konopka, J.A. et al. Fusions ending at the thoracolumbar junction in adolescent idiopathic scoliosis: comparison of lower instrumented vertebrae. Spine Deform 8, 205–211 (2020). https://doi.org/10.1007/s43390-020-00044-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-020-00044-1

Keywords

Search

Navigation