Abstract
Background
It is not clearly defined in the literature how the lowest instrumented vertebra (LIV) selection effects the rotation of lumbar vertebrae at fused and unfused levels in thoracolumbar/lumbar (TL/L) curves. The aim of this study was to evaluate the rotational profile of structural TL/L curves, corrected with rod derotation manoeuvre, according to LIV level.
Methods
82 consecutive AIS patients with structural TL/L curves who were treated with long segment posterior instrumentation and fusion were retrospectively evaluated. Patients were divided into three groups according to LIV level: lower end vertebra (LEV) group (32 patients), LEV−1 group (23 patients) and LEV + 1 group (27 patients). Cobb angles of structural curves, coronal and sagittal balance were evaluated with direct roentgenograms. Rotation of upper end vertebra, apical vertebra, LIV−1, LIV and LIV + 1 was evaluated with computerised tomography. Clinical outcomes were assessed using SRS-22 questionnaire.
Results
Mean follow-up time was 31 months (range 24–42 months). Preoperative LIV rotation was measured as 16.03°, 16.08° and 12.68° in LEV, LEV-1 and LEV + 1 groups, which changed postoperatively as 13.36°, 16.52° and 9.74° respectively. Postoperative LIV−1, LIV and LIV + 1 rotation values were significantly higher in LEV−1 group compared to LEV + 1 group. None of the patients developed coronal or sagittal imbalance. No significant differences were observed between the groups in terms of SRS-22 scores.
Conclusions
Axial rotation of LIV and vertebrae adjacent to LIV is higher when the fusion is stopped at LEV−1. However, higher rotation does not seem to cause poor radiologic and clinical outcomes in the last follow-up.
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Data Availability
Data generated or analyzed during this study are available from the corresponding author upon reasonable request.
References
Lee, S. M., Suk, S. I., & Chung, E. R. (2004). Direct vertebral rotation: A new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine, 29, 343–349. https://doi.org/10.1097/01.brs.0000109991.88149.19
Jankowski, P. P., Yaszay, B., Cidambi, K. R., Bartley, C. E., Bastrom, T. P., & Newton, P. O. (2018). The relationship between apical vertebral rotation and truncal rotation in adolescent idiopathic scoliosis using 3D reconstructions. Spine Deform, 6, 213–219. https://doi.org/10.1016/j.jspd.2017.10.003
Li, J., Hwang, S. W., Shi, Z., Yan, N., Yang, C., Wang, C., et al. (2011). Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in lenke 5c patients. Spine, 36, 1673–1678. https://doi.org/10.1097/BRS.0b013e3182091fba
Satake, K., Lenke, L. G., Kim, Y. J., Bridwell, K. H., Blanke, K. M., Sides, B., et al. (2005). Analysis of the lowest instrumented vertebra following anterior spinal fusion of thoracolumbar/lumbar adolescent idiopathic scoliosis: Can we predict postoperative disc wedging? Spine, 30, 418–426. https://doi.org/10.1097/01.brs.0000153342.89478.d2
Courvoisier, A., Garin, C., Vialle, R., & Kohler, R. (2015). The change on vertebral axial rotation after posterior instrumentation of idiopathic scoliosis. Childs Nervous System, 31, 2325–2331. https://doi.org/10.1007/s00381-015-2891-3
Zuckerman, S. L., Segar, A. H., Cerpa, M., Chanbour, H., Sardar, Z. M., & Lenke, L. G. (2022). Three-dimensional assessment of vertebral derotation in adolescent idiopathic scoliosis: Review of a surgical technique and its success in achieving derotation in the instrumented and uninstrumented spine. Oper Neurosurg (Hagerstown), 22(6), 380–386. https://doi.org/10.1227/ons.0000000000000156
Trobisch, P. D., Ducoffe, A. R., Lonner, B. S., & Errico, T. J. (2013). Choosing fusion levels in adolescent idiopathic scoliosis. Journal of American Academy of Orthopaedic Surgeons, 21, 519–528. https://doi.org/10.5435/JAAOS-21-09-519
Cotrel, Y., Dubousset, J., & Guillaumat, M. (1988). New universal instrumentation in spinal surgery. Clinical Orthopaedics and Related Research, 227, 10–23.
Ecker, M. L., Betz, R. R., Trent, P. S., Mahboubi, S., Mesgarzadeh, M., Bonakdapour, A., et al. (1988). Computer tomography evaluation in cotrel-dubousset instrumentation in idiopathic scoliosis. Spine, 13, 1141–1144. https://doi.org/10.1097/00007632-198810000-00015
Di Silvestre, M., Lolli, F., Bakaloudis, G., Maredi, E., Vommaro, F., & Pastorelli, F. (2013). Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis: Myth or reality? European Spine Journal, 22, 313–323. https://doi.org/10.1007/s00586-012-2372-2
Seki, S., Kawaguchi, Y., Nakano, M., Makino, H., Mine, H., & Kimura, T. (2016). Rod rotation and differential rod contouring followed by direct vertebral rotation for treatment of adolescent idiopathic scoliosis: Effect on thoracic and thoracolumbar or lumbar curves assessed with intraoperative computed tomography. Spine Journal, 16, 365–371. https://doi.org/10.1016/j.spinee.2015.11.032
Pasha, S., Cahill, P. J., Flynn, J. M., Sponseller, P., Newton, P. O., Harms Study Group. (2018). Relationships between the axial derotation of the lower instrumented vertebra and uninstrumented lumbar curve correction: Radiographic outcome in lenke 1 adolescent idiopathic scoliosis with a minimum 2-year follow-up. Journal of Pediatric Orthopaedics, 38, e194–e201. https://doi.org/10.1097/BPO.0000000000001136
Chang, D. G., Sl, S., Kim, J. H., et al. (2020). Long-term outcome of selective thoracic fusion using rod derotation and direct vertebral rotation in the treatment of thoracic adolescent idiopathic scoliosis: more than 10-year follow-up data. Clinical Spine Surgery, 33(2), E50–E57. https://doi.org/10.1097/BSD.0000000000000833
Zhuang, Q., Zhang, J., Wang, S., Yang, Y., & Lin, G. (2021). How to select the lowest instrumented vertebra in Lenke type 5 adolescent idiopathic scoliosis patients? Spine Journal, 21, 141–149. https://doi.org/10.1016/j.spinee.2020.08.006
Huang, Z., Wang, Q., Yang, J., Yang, J., & Li, F. (2016). Vertebral derotation by vertebral column manipulator improves postoperative radiographs outcomes of lenke 5c patients for follow-up of minimum 2 years. Clinical Spine Surgery, 29, E157–E161. https://doi.org/10.1097/BSD.0000000000000123
Hwang, S. W., Dubaz, O. M., Ames, R., Rothkrug, A., Kimball, J. S., & Samdani, A. F. (2012). The impact of direct vertebral body derotation on the lumbar prominence in lenke type 5c curves. Journal of Neurosurgery Spine, 17, 308–313. https://doi.org/10.3171/2012.7.SPINE12273
Boyer, L., Shen, J., Parent, S., Kadoury, S., & Aubin, C. E. (2018). Accuracy and precision of seven radiography-based measurement methods of vertebral axial rotation in adolescent idiopathic scoliosis. Spine Deform, 6, 351–357. https://doi.org/10.1016/j.jspd.2017.12.004
Yazici, M., Acaroglu, E. R., Alanay, A., Deviren, V., Cila, A., & Surat, A. (2001). Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis. Journal of Pediatric Orthopedics, 21(2), 252–256.
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Hakan Serhat Yanik and Ismail Emre Ketenci declare that they have no conflict of interest.
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Yanik, H.S., Ketenci, I.E. Rotational Assessment of Thoracolumbar/Lumbar Curves According to Lowest Instrumented Vertebra Level. JOIO 57, 2050–2057 (2023). https://doi.org/10.1007/s43465-023-01009-y
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DOI: https://doi.org/10.1007/s43465-023-01009-y