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Should the upper end vertebra be selected as the upper instrumented vertebra in patients with Lenke type 5C adolescent idiopathic scoliosis?

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Abstract

Study Design

Retrospective study.

Purpose

The upper end vertebra (UEV) is often selected as the upper instrumented vertebra (UIV) in patients with adolescent idiopathic scoliosis (AIS) with Lenke type 5C curves; however, the effect of adjusting UIV selection one level toward the cranial side (UEV + 1) is unknown. Therefore, this study aimed to assess the effect of UIV extension on scoliosis correction and global alignment in patients with the UIV as the UEV and UEV + 1.

Methods

Data of 52 patients with AIS with Lenke type 5C curves who underwent selective thoracolumbar/lumbar (TL/L) fusion with a minimum follow-up period of 2 years were retrospectively analyzed. The patients were divided according to the UIV in relation to the UEV: the UEV and UEV + 1 groups. Radiographic parameters and clinical outcomes were compared between the two groups.

Results

Among the 52 patients, 24 and 28 were included in the UEV and UEV + 1 group. Baseline data showed no intergroup differences except for the UIV level. While the UEV + 1 group showed a significantly greater TL/L curve correction (72.9% vs. 62.8%, p < 0.05) and a lower UIV tilt, it showed a significantly greater absolute value of radiographic shoulder height (RSH) (− 7.9 vs. − 0.9 mm, p < 0.05) and coronal balance (− 11.0 mm vs − 4.8 mm, p < 0.05) at 2 years postoperatively. The rate of post-operative shoulder imbalance (RSH ≥ 2 cm) was significantly higher in the UEV + 1 than in the UEV group. No intergroup differences were observed in the sagittal alignment and patient outcomes between the two groups.

Conclusion

When the UIV was selected as the UEV + 1, correction of the TL/L curve improved; however, it increased the risk of shoulder and coronal imbalance. There is no clinical benefit observed in terms of extending the UIV to the UEV + 1; therefore, the UIV should be selected as the UEV to maintain harmonious global alignment.

Level of evidence

Level 3.

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Acknowledgements

No other person aside from the authors made substantial contributions to conception, design, acquisition of data, or analysis and interpretation of data, or was involved in drafting the manuscript or revising it critically for important intellectual content. No funding was received for the design, in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. No language editor or scientific (medical) writer was involved in the preparation of the manuscript.

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Authors and Affiliations

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

    Tomohiro Banno, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Hideyuki Arima, Shin Oe, Yuki Mihara, Koichiro Ide & Yukihiro Matsuyama

  2. Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano, Japan

    Hiroki Oba & Jun Takahashi

  3. Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan

    Tetsuro Ohba & Hirotaka Haro

Authors
  1. Tomohiro Banno
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  2. Yu Yamato
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  3. Hiroki Oba
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Contributions

Conception or design of the work: TB, YYa, HO, TO, TH, GY, HA, SO, YM, KI, JT, HH, and YM. Acquisition of data for the work: TB, YY, HO, TO, and SO. Analysis of data for the work: TB. Interpretation of data for the work: TB, and YY. Drafting the work or revising it critically for important intellectual content: TB, YY, HO, TO, TH, GY, HA, SO, YM, KI, JT, HH, and YM. Final approval of the version to be published: TB, YY, HO, TO, TH, GY, HA, SO, YM, KI, JT, HH, and YM. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: TB, YY, HO, TO, TH, GY, HA, SO, YM, KI, JT, HH, and YM.

Corresponding author

Correspondence to Tomohiro Banno.

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Conflict of interest

TB, HO, TO, TH, GY, HA, YM, KI, JT, HH and YM have nothing to disclose. YY and SO belong to the division as follows; Donated Fund Laboratory (Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Shizuoka, Japan). Meitoku medical institute Jyuzen memorial hospital, Shizuoka, Japan. Japan Medical Dynamic Marketing Inc, Tokyo, Japan. Medtronic Sofamor Danek Inc., Memphis, United States.

IRB approval

This study design was approved by the appropriate ethics review boards in Hamamatsu University School of Medicine.

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Banno, T., Yamato, Y., Oba, H. et al. Should the upper end vertebra be selected as the upper instrumented vertebra in patients with Lenke type 5C adolescent idiopathic scoliosis?. Spine Deform 10, 1139–1148 (2022). https://doi.org/10.1007/s43390-022-00496-7

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  • DOI: https://doi.org/10.1007/s43390-022-00496-7

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