Abstract
Purpose
To determine fusion necessity to one level below lower-end vertebra (LEV+1) in selective posterior fusion of moderate thoracolumbar/lumbar (TL/L) idiopathic scoliosis.
Methods
A total of 37 patients with moderate TL/L idiopathic scoliosis (Cobb angle of TL/L curve between 30° and 60°) were identified and three patients with TL/L curve Cobb angle more than 60° were excluded. And the follow-up period was at least 2 years. Lowest instrumented vertebra (LIV) was one level proximal to LEV in three patients, LEV in 22 patients and LEV+1 in 12 patients. The three patients with TL/L Cobb angle more than 60° were all fused to LEV+1. Clinical and various radiographic measurements were collected before surgery, post-surgery and during last follow-up, and analytical comparisons were made between LIV = LEV patients and LIV = LEV+1 patients.
Results
No significant difference was observed regarding clinical and radiographic parameters between LEV group and LEV+1 group preoperatively except LIV disc angle and LIV translation. The correction rate of unfused thoracic curve and TL/L curve was 52.7 and 79.9 % in LEV group and 52.5 and 83.7 % in LEV+1 group at the last follow-up, indicating no significant difference (P = 0.976 and P = 0.415, respectively). Coronal balance and sagittal alignments were also comparable between the two groups. LIV translation was slightly less in LEV+1 group (P = 0.028) at the last follow-up on the basis that LEV+1 was less translated than LEV preoperatively.
Conclusions
Our analysis almost showed no benefit for fusing to LEV+1 in moderate TL/L idiopathic scoliosis patients undergoing posterior selective fusion with pedicle screws. For patients with TL/L Cobb angle more than 60°, the distal fusion level probably needs to be LEV+1.
Similar content being viewed by others
References
Qiu G, Zhang J, Wang Y, Xu H, Zhang J, Weng X, Lin J, Zhao Y, Shen J, Yang X, Luk KD, Lu D, Lu WW (2005) A new operative classification of idiopathic scoliosis: a peking union medical college method. Spine (Phila Pa 1976) 30:1419–1426
Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83-A:1169–1181
Sanchez-Raya J, Bago J, Pellise F, Cuxart A, Villanueva C (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. doi:10.1097/BSD.0b013e3182318622
Hayes MA, Tompkins SF, Herndon WA, Gruel CR, Kopta JA, Howard TC (1988) Clinical and radiological evaluation of lumbosacral motion below fusion levels in idiopathic scoliosis. Spine (Phila Pa 1976) 13:1161–1167
Tao F, Wang Z, Li M, Pan F, Shi Z, Zhang Y, Wu Y, Xie Y (2012) A comparison of anterior and posterior instrumentation for restoring and retaining sagittal balance in patients with idiopathic adolescent scoliosis. J Spinal Disord Tech 25:303–308. doi:10.1097/BSD.0b013e3182204c3e
Geck MJ, Rinella A, Hawthorne D, Macagno A, Koester L, Sides B, Bridwell K, Lenke L, Shufflebarger H (2009) Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices. Spine (Phila Pa 1976) 34:1942–1951. doi:10.1097/BRS.0b013e3181a3c777
Li M, Ni J, Fang X, Liu H, Zhu X, He S, Gu S, Wang X (2009) Comparison of selective anterior versus posterior screw instrumentation in Lenke5C adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 34:1162–1166. doi:10.1097/BRS.0b013e31819e2b16
Wang Y, Fei Q, Qiu G, Lee CI, Shen J, Zhang J, Zhao H, Zhao Y, Wang H, Yuan S (2008) Anterior spinal fusion versus posterior spinal fusion for moderate lumbar/thoracolumbar adolescent idiopathic scoliosis: a prospective study. Spine (Phila Pa 1976) 33:2166–2172. doi:10.1097/BRS.0b013e318185798d
Shufflebarger HL, Geck MJ, Clark CE (2004) The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976) 29:269–276
Halm H, Niemeyer T, Link T, Liljenqvist U (2000) Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis. Eur Spine J 9:191–197
Rose PS, Lenke LG (2007) Classification of operative adolescent idiopathic scoliosis: treatment guidelines. Orthop Clin North Am 38:521–529. doi:10.1016/j.ocl.2007.06.001
Uzumcugil O, Atici Y, Ozturkmen Y, Yalcinkaya M, Caniklioglu M (2012) Evaluation of shoulder balance through growing rod intervention for early-onset scoliosis. J Spinal Disord Tech 25:391–400. doi:10.1097/BSD.0b013e318227b52d
Liu Z, Guo J, Zhu Z, Qian B, Sun X, Xu L, Qiu Y (2013) Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion. Eur Spine J. doi:10.1007/s00586-013-2808-3
Li J, Hwang SW, Shi Z, Yan N, Yang C, Wang C, Zhu X, Hou T, Li M (2011) Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5C patients. Spine (Phila Pa 1976) 36:1673–1678. doi:10.1097/BRS.0b013e3182091fba
Wang Y, Bunger CE, Zhang Y, Wu C, Li H, Dahl B, Hansen ES (2013) Lowest instrumented vertebra selection for Lenke 5C scoliosis: a minimum 2-year radiographical follow-up. Spine (Phila Pa 1976) 38:E894–E900. doi:10.1097/BRS.0b013e31829537be
Zhang H, Hu X, Wang Y, Yin X, Tang M, Guo C, Liu S, Wang Y, Deng A, Liu J, Wu J (2013) Use of finite element analysis of a Lenke type 5 adolescent idiopathic scoliosis case to assess possible surgical outcomes. Comput Aided Surg 18:84–92. doi:10.3109/10929088.2012.763185
Bennett JT, Hoashi JS, Ames RJ, Kimball JS, Pahys JM, Samdani AF (2013) The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves. J Neurosurg Spine. doi:10.3171/2013.8.SPINE12816
Chen J, Yang C, Ran B, Wang Y, Wang C, Zhu X, Bai Y, Li M (2013) Correction of Lenke 5 adolescent idiopathic scoliosis using pedicle screw instrumentation: does implant density influence the correction? Spine (Phila Pa 1976) 38:E946–E951. doi:10.1097/BRS.0b013e318297bfd4
Lark RK, Yaszay B, Bastrom TP, Newton PO (2013) Adding thoracic fusion levels in Lenke 5 curves: risks and benefits. Spine (Phila Pa 1976) 38:195–200. doi:10.1097/BRS.0b013e3182634c85
Acknowledgments
This study was supported by no funding. We thank Mrs. Lee Jiayi for the revision of this manuscript.
Conflict of interest
No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sun, Z., Qiu, G., Zhao, Y. et al. Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra+1?. Eur Spine J 23, 1251–1257 (2014). https://doi.org/10.1007/s00586-014-3276-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-014-3276-0