Distal fusion level selection in Lenke 1A curves according to axial plane analyses

Erdemir, Cengiz; Musaoğlu, Resul; Selek, Özgür; Gök, Ümit; Şarlak, Ahmet Yılmaz

doi:10.1016/j.spinee.2015.07.004

Cited by 12 publications

(3 citation statements)

References 20 publications

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“…In thoracic scoliosis surgery, how to determine an optimal distal fusion level is still controversial. 4 Our results further revealed the special value in preserving the function of pelvic retroversion with selective fusion in lumbar segments. In our series, the pelvis was posteriorly rotated 11.5% in the STF group when the patients were seated, while no significant alteration of pelvic orientation was observed from standing to sitting when the distal fusion level was extended to L-3 or L-4 in the NSTF group (Table 4).…”

Section: Discussionsupporting

confidence: 57%

Postoperative changes in sagittal spinopelvic alignment in sitting position in adolescents with idiopathic thoracic scoliosis treated with posterior fusion: an initial analysis

Zhu¹,

Liu²,

Sha³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPrevious studies have reported spinal straightening and pelvic retroversion when changing from erect to sitting posture in patients with adolescent idiopathic scoliosis (AIS), which were thought to be related to low-back pain after sitting for long periods. However, the sitting sagittal alignment after posterior spinal fusion has not been evaluated. This study aims to assess the influence of posterior fusion surgery upon sitting sagittal spinopelvic alignment in adolescents with idiopathic thoracic curves (thoracic AIS [T-AIS]).METHODSA total of 44 T-AIS patients (30 Lenke I and 14 Lenke II) from the authors’ center were included in this study. Preoperative and postoperative long-cassette lateral radiographs of the spine and pelvis were obtained with the patients in standing and sitting positions. Thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured on standing and sitting lateral radiographs. Patients were divided into selective thoracic fusion (STF) and nonselective thoracic fusion (NSTF) groups.RESULTSAt baseline, TK, LL, and SS decreased by 27.5%, 42.1%, and 31.1%, respectively, from the standing to the sitting position, while PT increased by 193.6%. After posterior spinal fusion, increased TK, LL, and SS and corresponding decreased PT were observed compared to baseline parameters in the sitting position. Comparison of postoperative sitting and standing values for the whole cohort showed that the mean LS and SS values were significantly lower in the sitting position (decreased by 14.0% and 13.9%, respectively, compared to standing), whereas the mean PT value was significantly greater (increased by 39.0%, compared to standing). Similar changes were also observed in the STF group: postoperatively the mean LL value was 15.6% lower in sitting than in standing, while the mean SS value was 11.5% lower. However, no obvious changes of the postoperative values in sitting were found in the NSTF group.CONCLUSIONSNonselective thoracic fusion surgery in T-AIS patients diminished spinal straightening and pelvic retroversion during sitting. Reducing distal fusion levels was of special value in not only saving more lumbar mobility, but also preserving the function of pelvic posterior rotation.

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Section: Discussionsupporting

confidence: 57%

Postoperative changes in sagittal spinopelvic alignment in sitting position in adolescents with idiopathic thoracic scoliosis treated with posterior fusion: an initial analysis

Zhu¹,

Liu²,

Sha³

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…Miyanji et al 18 suggested that, for adolescent patients with idiopathic scoliosis whose L4 tilted to the right, selecting NV-1 or NV as LIV can avoid AOP after surgery. Erdemir et al 19 and Suk et al 20 also suggested choosing NV-1 or NV as LIV to avoid postoperative AOP. Therefore, we suggest that for patients with a malformation in the right hemivertebrae, the fusion segment can be extended correspondingly to prevent the occurrence of postoperative AOP.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of the Risk Factors for Adding-on Phenomena After Posterior Hemivertebral Resection and Pedicle Screw Fixation for the Treatment of Congenital Scoliosis Caused by Hemivertebral Malformation

Bao¹,

Yan²,

Tang³

et al. 2022

TCRM

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Objective To retrospectively analyze the risk factors for adding-on phenomena (AOP) after posterior hemivertebral resection (PHR) and pedicle screw fixation for the treatment of congenital scoliosis (CS) caused by hemivertebral (HV) malformation. Methods Patients with CS who underwent surgery and were followed up for more than five years were included in this study. The d general data, such as gender, age, HV segment, Risser sign, and triangular cartilage, postoperative complications, and imaging data at different periods, including the standard anteroposterior and lateral x-rays of the total spine were collected. Results In total, 58 patients were included in this study, of which 10 experienced AOP and 48 did not. The results of the single-factor analysis showed that there were statistically significant differences between the patients with AOP and those without in terms of the HV direction, lowest instrumented vertebra (LIV)–upper instrumented vertebra (UIV) (P < 0.05), and postoperative trunk shift (P < 0.05). The results of the logistic regression analysis showed that the HV direction and the postoperative trunk displacement distance were the main risk factors for postoperative AOP. The area under the receiver operating characteristic curve was 0.842 (P < 0.001). The best cut-off value of the adding-on index as an indicator of the occurrence of AOP after surgery was 0.67. When the adding-on index was >0.67, the incidence of postoperative AOP was 90.0%, and the non-occurrence rate was 22.9%. Conclusion PHR and pedicle screw fixation is an effective way to treat HV malformation in CS. The HV direction, LIV–UIV, and postoperative TS are risk factors for AOP in patients with CS treated with PHR and pedicle screw fixation. The adding-on index has a high degree of accuracy for the prediction of the occurrence of AOP after PHR and pedicle screw fixation.

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“…For patients with NV close to EV, Suk et al [86] recommended fusion to the neutral vertebra (NV) or NV-1. However, manual identification of NV and EV has been criticized to be unreliable among observers [87,88]. Based on 3D analysis of axial rotation, Pasha et al [70] suggested that the shape of axial projection may reflect the relationship between NV and EV and could be a potential determinant of fusion level for optimal postoperative alignment.…”

Section: Patient-related Factors and Eiv Selectionmentioning

confidence: 99%

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Wan

Wong

et al. 2023

Eur Spine J

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Background Restoration of three-dimensional (3D) alignment is critical in correcting patients with adolescent idiopathic scoliosis using posterior spinal fusion (PSF). However, current studies mostly rely on 2D radiographs, resulting in inaccurate assessment of surgical correction and underlying predictive factors. While 3D reconstruction of biplanar radiographs is a reliable and accurate tool for quantifying spinal deformity, no study has reviewed the current literature on its use in evaluating surgical prognosis. Purpose To summarize the current evidence on patient and surgical factors affecting sagittal alignment and curve correction after PSF based on 3D parameters derived from reconstruction of biplanar radiographs. Methods A comprehensive search was conducted by three independent investigators on Medline, PubMed, Web of Science, and Cochrane Library to obtain all published information on predictors of postoperative alignment and correction after PSF. Search items included "adolescent idiopathic scoliosis," "stereoradiography," "three-dimensional," "surgical,” and "correction." The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations approach. 989 publications were identified, with 444 unique articles subjected to full-text screening. Ultimately, 41 articles were included. Results Strong predictors of better curve correction included preoperative normokyphosis (TK > 15°), a corresponding rod contour, intraoperative vertebral rotation and translation, and upper and lower instrumented vertebrae selected based on sagittal and axial inflection points. For example, for Lenke 1 patients with junctional vertebrae above L1, fusion to NV-1 (1 level above the neutral vertebra) achieved optimal curve correction while preserving motion segments. Pre-op coronal Cobb angle and axial rotation, distal junctional kyphosis, pelvic incidence, sacral slope, and type of instrument were identified as predictors with moderate evidence. For Lenke 1C patients, > 50% LIV rotation was found to increase spontaneous lumbar curve correction. Pre-op thoracolumbar apical translation and lumbar lordosis, Ponte osteotomies, and rod material were found to be predictors with low evidence. Conclusions Rod contouring and UIV/LIV selection should be based on preoperative 3D TK in order to achieve normal postoperative alignment. Specifically, Lenke 1 patients with high-lying rotations should be fused distally at NV-1, while hypokyphotic patients with large lumbar curves and truncal shift should be fused at NV to improve lumbar alignment. Lenke 1C curves should be corrected using > 50% LIV rotation counterclockwise to the lumbar rotation. Further investigation should compare surgical correction between pedicle-screw and hybrid constructs using matched cohorts. DJK and overbending rods are potential predictors of postoperative alignment.

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Distal fusion level selection in Lenke 1A curves according to axial plane analyses

Cited by 12 publications

References 20 publications

Postoperative changes in sagittal spinopelvic alignment in sitting position in adolescents with idiopathic thoracic scoliosis treated with posterior fusion: an initial analysis

Postoperative changes in sagittal spinopelvic alignment in sitting position in adolescents with idiopathic thoracic scoliosis treated with posterior fusion: an initial analysis

An Analysis of the Risk Factors for Adding-on Phenomena After Posterior Hemivertebral Resection and Pedicle Screw Fixation for the Treatment of Congenital Scoliosis Caused by Hemivertebral Malformation

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

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