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Excessive posterior placement of upper instrumented vertebra relative to lower instrumented vertebra as a predictor of proximal junction kyphosis after selective spinal fusion for adolescent idiopathic scoliosis Lenke type 5C curves

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Abstract

Purpose

We defined sagittal S-line tilt (SSLT) as the tilt of the line connecting the upper instrumented vertebra and the lower instrumented vertebra. This study aimed to: (1) examine the correlation between SSLT and proximal junctional angle (PJA) change values, and (2) determine the cut-off value of SSLT with respect to proximal junctional kyphosis (PJK) occurrence.

Methods

Eighty-six consecutive patients (81 female and 5 male; mean age: 15.8 years) with Lenke 5C AIS who underwent posterior selective spinal fusion. Pearson’s correlation coefficients were used to examine the relationship between preoperative SSLT and changes in PJA from preoperative to 2 years postoperative. The impact of SSLT on PJK at 2 years after surgery was assessed using a receiver operating characteristic (ROC) curve.

Results

We observed a moderate positive correlation between preoperative SSLT and change in PJA (R = 0.541, P < 0.001). We identified 18 patients (21%) with PJK at 2 years postoperative. Mean preoperative SSLT in the PJK group and the non-PJK group differed significantly at 23.3 ± 4.1° and 16.1 ± 5.0°, respectively (P < 0.001). The cut-off value of preoperative SSLT for PJK at 2 years postoperative was 18° in ROC curve analysis, with a sensitivity of 94%, specificity of 68%, and area under the ROC curve of 0.868.

Conclusion

In selective lumbar fusion for AIS Lenke type 5C curves, preoperative SSLT was significantly correlated with PJA change from preoperative to 2 years postoperative. SSLT was a predictor of PJK occurrence, with a cut-off value of 18°.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Hiroki Oba, Shota Ikegami, Masashi Uehara, Tetsuhiko Mimura, Terue Hatakenaka, Yoshinari Miyaoka, Daisuke Kurogochi, Takuma Fukuzawa, Shinji Sasao & Jun Takahashi

  2. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, Shizuoka, 431-3192, Japan

    Tomohiro Banno & Yukihiro Matsuyama

  3. Department of Orthopaedic Surgery, University of Yamanashi School of Medicine, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Tetsuro Ohba & Hirotaka Haro

  4. Faculty of Textile Science and Technology, Shinshu University, 3-15-1 Tokida, Ueda, Nagano, 386-8567, Japan

    Michihiko Koseki

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  1. Hiroki Oba
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Correspondence to Hiroki Oba.

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586_2024_8427_MOESM1_ESM.pptx

Supplementary file1 Association between preoperative sagittal S-line tilt (SSLT) and preoperative sagittal vertical axis (SVA) (PPTX 47 KB)

Supplementary file2 (DOCX 40 KB)

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Oba, H., Banno, T., Ohba, T. et al. Excessive posterior placement of upper instrumented vertebra relative to lower instrumented vertebra as a predictor of proximal junction kyphosis after selective spinal fusion for adolescent idiopathic scoliosis Lenke type 5C curves. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08427-y

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