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Article: Selection of the lowest instrumented vertebra in main thoracic adolescent idiopathic scoliosis: Is it safe to fuse shorter than the last touched vertebra?

TitleSelection of the lowest instrumented vertebra in main thoracic adolescent idiopathic scoliosis: Is it safe to fuse shorter than the last touched vertebra?
Authors
KeywordsAdolescent idiopathic scoliosis
Fusion selection
Adding-on
Last touched vertebrae
Flexibility
Issue Date2020
PublisherSpringer. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/586
Citation
European Spine Journal, 2020, Epub 2020-04-03 How to Cite?
AbstractHypothesis: Fusing shorter than the last touched vertebra (LTV) is a safe approach in flexible main thoracic (MT) adolescent idiopathic scoliosis (AIS) curves. Methods: This was a prospective study on consecutive AIS patients surgically treated with selective fusion of the MT curve. Fusion-level selection was based on the fulcrum-bending radiograph method. Patients were grouped based on the position of the lowest instrumented vertebra as proximal to the LTV (proxLTV, n = 43), at the LTV (atLTV, n = 45), and distal to the LTV (distLTV, n = 21). Results: A total of 109 patients were included in the study. Preoperatively, the distLTV group had greater lumbar Cobb angle, lumbar apical translation, and less flexibility in the MT curve. At 2-year follow-up, the groups did not differ in MT curve correction, but the distLTV had larger lumbar Cobb angle, more apical translation, and worse coronal balance. Distal adding-on was observed in 11 patients (26%) in the proxLTV group, four patients (9%) in the atLTV group, and one patient (5%) in the distLTV group (p = 0.031). Adding-on was associated with younger patients and lower Risser grade at the time of surgery but not with any other radiographic parameter. No differences in SRS-22r scores were observed between the groups. Conclusions: Proximal fusion carries the risk of adding-on, but leaving unfused segments in the lower spine increases the potential for compensatory mechanisms to improve spinal and truncal balance. In mature patients with a flexible MT curve, surgeons may consider fusion at or cranial to the LTV.
Persistent Identifierhttp://hdl.handle.net/10722/283251
ISSN
2019 Impact Factor: 2.458
2015 SCImago Journal Rankings: 0.972

 

DC FieldValueLanguage
dc.contributor.authorOhrt-Nissen, S-
dc.contributor.authorLuk, KDK-
dc.contributor.authorSamartzis, D-
dc.contributor.authorCheung, JPY-
dc.date.accessioned2020-06-22T02:54:08Z-
dc.date.available2020-06-22T02:54:08Z-
dc.date.issued2020-
dc.identifier.citationEuropean Spine Journal, 2020, Epub 2020-04-03-
dc.identifier.issn0940-6719-
dc.identifier.urihttp://hdl.handle.net/10722/283251-
dc.description.abstractHypothesis: Fusing shorter than the last touched vertebra (LTV) is a safe approach in flexible main thoracic (MT) adolescent idiopathic scoliosis (AIS) curves. Methods: This was a prospective study on consecutive AIS patients surgically treated with selective fusion of the MT curve. Fusion-level selection was based on the fulcrum-bending radiograph method. Patients were grouped based on the position of the lowest instrumented vertebra as proximal to the LTV (proxLTV, n = 43), at the LTV (atLTV, n = 45), and distal to the LTV (distLTV, n = 21). Results: A total of 109 patients were included in the study. Preoperatively, the distLTV group had greater lumbar Cobb angle, lumbar apical translation, and less flexibility in the MT curve. At 2-year follow-up, the groups did not differ in MT curve correction, but the distLTV had larger lumbar Cobb angle, more apical translation, and worse coronal balance. Distal adding-on was observed in 11 patients (26%) in the proxLTV group, four patients (9%) in the atLTV group, and one patient (5%) in the distLTV group (p = 0.031). Adding-on was associated with younger patients and lower Risser grade at the time of surgery but not with any other radiographic parameter. No differences in SRS-22r scores were observed between the groups. Conclusions: Proximal fusion carries the risk of adding-on, but leaving unfused segments in the lower spine increases the potential for compensatory mechanisms to improve spinal and truncal balance. In mature patients with a flexible MT curve, surgeons may consider fusion at or cranial to the LTV.-
dc.languageeng-
dc.publisherSpringer. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/586-
dc.relation.ispartofEuropean Spine Journal-
dc.subjectAdolescent idiopathic scoliosis-
dc.subjectFusion selection-
dc.subjectAdding-on-
dc.subjectLast touched vertebrae-
dc.subjectFlexibility-
dc.titleSelection of the lowest instrumented vertebra in main thoracic adolescent idiopathic scoliosis: Is it safe to fuse shorter than the last touched vertebra?-
dc.typeArticle-
dc.identifier.emailCheung, JPY: cheungjp@hku.hk-
dc.identifier.authorityLuk, KDK=rp00333-
dc.identifier.authorityCheung, JPY=rp01685-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s00586-020-06398-4-
dc.identifier.pmid32242322-
dc.identifier.scopuseid_2-s2.0-85082833032-
dc.identifier.hkuros310629-
dc.identifier.volumeEpub 2020-04-03-
dc.publisher.placeGermany-

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