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Optimal Lowest Instrumented Vertebra for Thoracic Adolescent Idiopathic Scoliosis

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Abstract

Study Design

Retrospective cohort chart review.

Objective

To determine the optimal lowest instrumented vertebra (LIV) following posterior segmental spinal instrumented fusion (PSSIF) of thoracic adolescent idiopathic scoliosis (AIS) with LIV at L2 or above.

Summary of Background Data

Few studies evaluate the optimal LIV based on rotation or center sacral vertical line (CSVL).

Methods

A radiographic assessment of 544 thoracic major AIS patients (average age 14.7 years) with minimum 2 years’ follow-up (average 4.1 years) after PSSIF was performed. The LIV was divided by CSVL: stable vertebra 1 (SV-1) if the CSVL fell between the medial walls of the LIV pedicles; SV-2 if between stable vertebra 1 and 3; and SV-3 if the CSVL did not touch the LIV. LIV was divided by rotation into: neutral vertebra 0 (NV-0) if the LIV was at or distal to the neutral vertebra; NV-1 if one vertebra proximal to the NV; NV-2 if two vertebrae proximal; and NV-3 if three vertebrae proximal to the NV.

Results

The prevalence of adding-on (AO) or distal junctional kyphosis (DJK) at ultimate follow-up was 13.6%. Patients with AO or DJK had a higher rate of open triradiate cartilage, LIV not touching the CSVL, and more proximal to the NV (p < .05). Risk factors were SV-3 (39% vs. SV-2 14%, SV-1 9%, p < .05), NV-3 (35% vs. NV-2 9%, NV-1 6%, NV-0 12%, p = .000), open triradiate cartilage (43% vs. closed 13%, p < .05), lumbar C modifier (22% vs. B modifier 8%, A modifier 13%, p < .05), and Risser stage 0 (19% vs. 12% Risser 1–5, p < .05).

Conclusion

The prevalence of AO or DJK at ultimate follow-up of PSSIF for AIS with LIV at L2 or above was 13.6%. Risk factors included the CSVL outside the LIV, LIV 3 or more proximal to the NV, open triradiate cartilage, lumbar C modifier, and Risser stage 0.

Level of Evidence

Level IV.

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Authors and Affiliations

  1. Hospital for Joint Diseases, NYU Langone Medical Center, 246 East 20th Street, 10003, New York, NY, USA

    Charla R. Fischer MD

  2. Spine/Scoliosis Service, Columbia University, New York, NY, USA

    Lawrence G. Lenke MD & Yongjung J. Kim MD

  3. Orthopaedic Surgery, Washington University in St. Louis, MO, USA

    Keith H. Bridwell MD & Munish Gupta MD

  4. Spine/Scoliosis Service, Hospital for Special Surgery, New York, NY, USA

    Oheneba Boachie-Adjei MD

Authors
  1. Charla R. Fischer MD
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  2. Lawrence G. Lenke MD
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  3. Keith H. Bridwell MD
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  4. Oheneba Boachie-Adjei MD
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  5. Munish Gupta MD
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  6. Yongjung J. Kim MD
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Corresponding author

Correspondence to Charla R. Fischer MD.

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Fischer, C.R., Lenke, L.G., Bridwell, K.H. et al. Optimal Lowest Instrumented Vertebra for Thoracic Adolescent Idiopathic Scoliosis. Spine Deform 6, 250–256 (2018). https://doi.org/10.1016/j.jspd.2017.10.002

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  • DOI: https://doi.org/10.1016/j.jspd.2017.10.002

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