Importance of lowest instrumented vertebra on clinical and radiological outcomes in patients with Lenke type 3C adolescent idiopathic scoliosis: a minimum 4-year follow-up

Abstract

The purpose of this retrospective study was to determine the most appropriate distal fusion level in terms of clinical results and radiological changes in Lenke 3C adolescent idiopathic scoliosis (AIS). Between June 2010 and May 2014, a total of 90 consecutive patients who underwent surgery for Lenke 3C AIS were divided into three groups as L2, L3, and L4 according to the fusion levels and compared in terms of functional and radiological outcomes. Patients were evaluated with Scoliosis Research Society 22 (SRS 22) and the Oswestry disability index (ODI) at the final follow-up. Preoperative standard posteroanterior and lateral whole-spine radiographs and lateral bending radiographs were used to evaluate the curves. All patients were also assessed with lumbar MRI at the final follow-up, and classified for each patient in terms of disc degeneration (DD) and facet joint degeneration (FJD). There was a statistically significant difference between the groups in terms of ODI category (P = 0.001). The rate of minimal disability in the L3 group, moderate disability in the L2 group, and severe disability in the L4 group were higher. Statistically significant differences were observed between the groups in terms of pain, body image, mental health, and total score distribution from the SRS-22 domains (P < 0.05). No significant difference was observed between the groups in terms of DD and FJD in MRI (P = 0.263). Although the preoperative functional scores could not be evaluated due to the retrospective nature of the study, it was observed that the only significant difference between the groups was the SRS-22 score. The best SRS-22 score was obtained in patients in whom fusion was stopped at L3.

Health‐related Quality of Life (HRQOL) Outcomes of Selective/Nonselective Thoracic Fusion for Lenke 1C Adolescent Idiopathic Scoliosis (AIS) Patients with a Minimum 4‐year Follow‐up

“…The ODI has 10 questions and primarily reflects disability in activities of daily living. Totals were calculated and expressed as 0%–100%, where 0% represents normal and 100% represents the most severe disability 27,28 …”

“…Totals were calculated and expressed as 0%-100%, where 0% represents normal and 100% represents the most severe disability. 27,28 Radiographic Assessment For radiographic evaluation, we collected the spine X-ray films of all patients within 1 week before the operation, within 1 week after the operation and at the last follow-up (at least 4 years). Two attending spinal surgeons measured the Cobb angle of the main thoracic (MT) curve and the thoracolumbar/lumbar (TL/L) curve on the spinal X-rays of each patient before and after surgery, as well as during the final follow-up, and their average value was adopted.…”

Comparison of Functional and Radiological Outcomes of Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion Techniques in the Treatment of Lumbar Spinal Stenosis

“…Radiological evaluation was conducted through the examination of adjacent vertebrae, posterior ligamentous complex (PLC) morphology, and sagittal balance on MRI at last control. The MRIs were graded between 1 and 5 for lumbar disc degeneration according to Pfirrmannʼs classification and facet joint degeneration according to Fujiwaraʼs classification (Grade 1: normal; Grade 2: joint space narrowing or mild osteophyte; Grade 3: sclerosis or marked osteophyte; Grade 4: marked osteophyte) 13 , 14 , 15 . Patients classified as higher than grade 3 were defined to have disc degeneration.…”

Surgical Level Selection in Adolescent Idiopathic Scoliosis: An Evidence-Based Approach

“…In a study of Lenke 3C curves to determine the optimal LIV with patients fused to L2, L3, or L4, the authors evaluated final follow-up lumbar MRI, SRS-22, and Oswestry Disability Index scores. 34 They reported no notable difference between groups for disk or facet joint degeneration. However, differences in ODI scores were statistically significant, with minimal disability, moderate disability, and severe disability highest in the L3, L2, and L4 groups, respectively.…”