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Lowest instrumented vertebra selection in Lenke 3C and 6C scoliosis: what if we choose lumbar apical vertebra as distal fusion end?

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Abstract

Purpose

The aim of this study was to investigate whether or not post-op curve behaviour differs due to different choices of lowest instrumented vertebra (LIV) with reference to lumbar apical vertebra (LAV) in Lenke 3C and 6C scoliosis.

Methods

We reviewed all the AIS cases surgically treated in our institution from 2002 through 2008. Inclusion criteria were as follows: (1) patients with Lenke 3C or 6C scoliosis who were treated with posterior pedicle screw-only constructs; (2) 2-year radiographic follow-up. All the included patients were categorized into three groups based on the relative position of LIV and LAV: Group A—the LIV was above the LAV; Group B—the LIV was at the LAV; Group C—the LIV was below the LAV. All the radiographic parameters were then compared among the groups. All image data were available in our picture archiving and communication systems. Standing anteroposterior (AP) and lateral digital radiographs were reviewed at four times (pre-op, post-op, 3-month and 2-year). In each standing AP radiograph, centre sacral vertical line (CSVL, the vertical line that bisects the proximal sacrum) was first drawn, followed by measuring T1-CSVL, LIV-CSVL, (LIV + 1)-CSVL, LAV-CSVL and thoracic AV-CSVL distance. In addition, the Cobb angles of major thoracic and lumbar curves were measured at the four times and the correction rates were then calculated.

Results

Of the 278 patients reviewed, 40 met the inclusion criteria; 11 of these were included in Group A (LIV above LAV), another 11 in Group B (LIV at LAV) and the remaining 18 in Group C (LIV below LAV). At 2-year follow-up, the lumbar vertebrae such as LIV, LIV + 1 and LAV were all more deviated than before surgery in Group A (LIV above LAV), whereas in Group B and C (LIV at and below LAV) they were all less deviated than before surgery. No significant differences were found in thoracic or lumbar correction rate, global coronal balance and incidence rate of trunk shift among the three groups.

Conclusion

In conclusion, in Lenke 3C and 6C scoliosis, post-op lumbar curve behaviour differs due to different choices of LIV with reference to LAV, that is, the deviation of lumbar curve improves when the LIV is either at or below the LAV but deteriorates when the LIV is above the LAV. Although the greatest correction occurs when the LIV is below the LAV, choosing LAV as LIV can still be the optimal option in certain cases, since it can yield similar correction while preserving more lumbar mobility and growth potential.

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Acknowledgements

The authors thank the Danish Strategic Research Council for financial support. The authors thank Linda Marie Nygaard for her revisions of the manuscript, and also thank Astrid Hedegaard Konradsen for her excellent work in radiographic follow-up.

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Authors and Affiliations

  1. Department of Orthopaedics E, Aarhus University Hospital, Norrebrogade 44, 8000, Aarhus, Denmark

    Yu Wang, Cody Eric Bünger, Yanqun Zhang & Ebbe Stender Hansen

  2. Department of Orthopaedics, Peking University First Hospital, Xicheng District, Beijing, 100034, China

    Yu Wang

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  1. Yu Wang
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  2. Cody Eric Bünger
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  3. Yanqun Zhang
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Correspondence to Yu Wang.

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Wang, Y., Bünger, C.E., Zhang, Y. et al. Lowest instrumented vertebra selection in Lenke 3C and 6C scoliosis: what if we choose lumbar apical vertebra as distal fusion end?. Eur Spine J 21, 1053–1061 (2012). https://doi.org/10.1007/s00586-011-2058-1

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  • DOI: https://doi.org/10.1007/s00586-011-2058-1

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