Skip to main content
SpringerLink
Log in

Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra+1?

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To determine fusion necessity to one level below lower-end vertebra (LEV+1) in selective posterior fusion of moderate thoracolumbar/lumbar (TL/L) idiopathic scoliosis.

Methods

A total of 37 patients with moderate TL/L idiopathic scoliosis (Cobb angle of TL/L curve between 30° and 60°) were identified and three patients with TL/L curve Cobb angle more than 60° were excluded. And the follow-up period was at least 2 years. Lowest instrumented vertebra (LIV) was one level proximal to LEV in three patients, LEV in 22 patients and LEV+1 in 12 patients. The three patients with TL/L Cobb angle more than 60° were all fused to LEV+1. Clinical and various radiographic measurements were collected before surgery, post-surgery and during last follow-up, and analytical comparisons were made between LIV = LEV patients and LIV = LEV+1 patients.

Results

No significant difference was observed regarding clinical and radiographic parameters between LEV group and LEV+1 group preoperatively except LIV disc angle and LIV translation. The correction rate of unfused thoracic curve and TL/L curve was 52.7 and 79.9 % in LEV group and 52.5 and 83.7 % in LEV+1 group at the last follow-up, indicating no significant difference (P = 0.976 and P = 0.415, respectively). Coronal balance and sagittal alignments were also comparable between the two groups. LIV translation was slightly less in LEV+1 group (P = 0.028) at the last follow-up on the basis that LEV+1 was less translated than LEV preoperatively.

Conclusions

Our analysis almost showed no benefit for fusing to LEV+1 in moderate TL/L idiopathic scoliosis patients undergoing posterior selective fusion with pedicle screws. For patients with TL/L Cobb angle more than 60°, the distal fusion level probably needs to be LEV+1.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Qiu G, Zhang J, Wang Y, Xu H, Zhang J, Weng X, Lin J, Zhao Y, Shen J, Yang X, Luk KD, Lu D, Lu WW (2005) A new operative classification of idiopathic scoliosis: a peking union medical college method. Spine (Phila Pa 1976) 30:1419–1426

    Article  Google Scholar 

  2. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83-A:1169–1181

    CAS  PubMed  Google Scholar 

  3. Sanchez-Raya J, Bago J, Pellise F, Cuxart A, Villanueva C (2012) Does the lower instrumented vertebra have an effect on lumbar mobility, subjective perception of trunk flexibility, and quality of life in patients with idiopathic scoliosis treated by spinal fusion? J Spinal Disord Tech 25:437–442. doi:10.1097/BSD.0b013e3182318622

    Article  PubMed  Google Scholar 

  4. Hayes MA, Tompkins SF, Herndon WA, Gruel CR, Kopta JA, Howard TC (1988) Clinical and radiological evaluation of lumbosacral motion below fusion levels in idiopathic scoliosis. Spine (Phila Pa 1976) 13:1161–1167

    Article  CAS  Google Scholar 

  5. Tao F, Wang Z, Li M, Pan F, Shi Z, Zhang Y, Wu Y, Xie Y (2012) A comparison of anterior and posterior instrumentation for restoring and retaining sagittal balance in patients with idiopathic adolescent scoliosis. J Spinal Disord Tech 25:303–308. doi:10.1097/BSD.0b013e3182204c3e

    Article  PubMed  Google Scholar 

  6. Geck MJ, Rinella A, Hawthorne D, Macagno A, Koester L, Sides B, Bridwell K, Lenke L, Shufflebarger H (2009) Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices. Spine (Phila Pa 1976) 34:1942–1951. doi:10.1097/BRS.0b013e3181a3c777

    Article  Google Scholar 

  7. Li M, Ni J, Fang X, Liu H, Zhu X, He S, Gu S, Wang X (2009) Comparison of selective anterior versus posterior screw instrumentation in Lenke5C adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 34:1162–1166. doi:10.1097/BRS.0b013e31819e2b16

    Article  Google Scholar 

  8. Wang Y, Fei Q, Qiu G, Lee CI, Shen J, Zhang J, Zhao H, Zhao Y, Wang H, Yuan S (2008) Anterior spinal fusion versus posterior spinal fusion for moderate lumbar/thoracolumbar adolescent idiopathic scoliosis: a prospective study. Spine (Phila Pa 1976) 33:2166–2172. doi:10.1097/BRS.0b013e318185798d

    Article  Google Scholar 

  9. Shufflebarger HL, Geck MJ, Clark CE (2004) The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976) 29:269–276

    Article  Google Scholar 

  10. Halm H, Niemeyer T, Link T, Liljenqvist U (2000) Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis. Eur Spine J 9:191–197

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Rose PS, Lenke LG (2007) Classification of operative adolescent idiopathic scoliosis: treatment guidelines. Orthop Clin North Am 38:521–529. doi:10.1016/j.ocl.2007.06.001

    Article  PubMed  Google Scholar 

  12. Uzumcugil O, Atici Y, Ozturkmen Y, Yalcinkaya M, Caniklioglu M (2012) Evaluation of shoulder balance through growing rod intervention for early-onset scoliosis. J Spinal Disord Tech 25:391–400. doi:10.1097/BSD.0b013e318227b52d

    Article  PubMed  Google Scholar 

  13. Liu Z, Guo J, Zhu Z, Qian B, Sun X, Xu L, Qiu Y (2013) Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion. Eur Spine J. doi:10.1007/s00586-013-2808-3

    Google Scholar 

  14. Li J, Hwang SW, Shi Z, Yan N, Yang C, Wang C, Zhu X, Hou T, Li M (2011) Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5C patients. Spine (Phila Pa 1976) 36:1673–1678. doi:10.1097/BRS.0b013e3182091fba

    Article  Google Scholar 

  15. Wang Y, Bunger CE, Zhang Y, Wu C, Li H, Dahl B, Hansen ES (2013) Lowest instrumented vertebra selection for Lenke 5C scoliosis: a minimum 2-year radiographical follow-up. Spine (Phila Pa 1976) 38:E894–E900. doi:10.1097/BRS.0b013e31829537be

    Article  Google Scholar 

  16. Zhang H, Hu X, Wang Y, Yin X, Tang M, Guo C, Liu S, Wang Y, Deng A, Liu J, Wu J (2013) Use of finite element analysis of a Lenke type 5 adolescent idiopathic scoliosis case to assess possible surgical outcomes. Comput Aided Surg 18:84–92. doi:10.3109/10929088.2012.763185

    Article  CAS  PubMed  Google Scholar 

  17. Bennett JT, Hoashi JS, Ames RJ, Kimball JS, Pahys JM, Samdani AF (2013) The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves. J Neurosurg Spine. doi:10.3171/2013.8.SPINE12816

    PubMed  Google Scholar 

  18. Chen J, Yang C, Ran B, Wang Y, Wang C, Zhu X, Bai Y, Li M (2013) Correction of Lenke 5 adolescent idiopathic scoliosis using pedicle screw instrumentation: does implant density influence the correction? Spine (Phila Pa 1976) 38:E946–E951. doi:10.1097/BRS.0b013e318297bfd4

    Article  Google Scholar 

  19. Lark RK, Yaszay B, Bastrom TP, Newton PO (2013) Adding thoracic fusion levels in Lenke 5 curves: risks and benefits. Spine (Phila Pa 1976) 38:195–200. doi:10.1097/BRS.0b013e3182634c85

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by no funding. We thank Mrs. Lee Jiayi for the revision of this manuscript.

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China

    Zhijian Sun, Guixing Qiu, Yu Zhao, Yipeng Wang, Jianguo Zhang & Jianxiong Shen

Authors
  1. Zhijian Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guixing Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yipeng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jianguo Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jianxiong Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yu Zhao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sun, Z., Qiu, G., Zhao, Y. et al. Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra+1?. Eur Spine J 23, 1251–1257 (2014). https://doi.org/10.1007/s00586-014-3276-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3276-0

Keywords

Search

Navigation