Optimal Lowest Instrumented Vertebra for Thoracic Adolescent Idiopathic Scoliosis

Charla R. Fischer, Lawrence G. Lenke, Keith H. Bridwell, Oheneba Boachie-Adjei, Munish Gupta, Yongjung J. Kim

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study Design: Retrospective cohort chart review. Objective: To determine the optimal lowest instrumented vertebra (LIV) following posterior segmental spinal instrumented fusion (PSSIF) of thoracic adolescent idiopathic scoliosis (AIS) with LIV at L2 or above. Summary of Background Data: Few studies evaluate the optimal LIV based on rotation or center sacral vertical line (CSVL). Methods: A radiographic assessment of 544 thoracic major AIS patients (average age 14.7 years) with minimum 2 years' follow-up (average 4.1 years) after PSSIF was performed. The LIV was divided by CSVL: stable vertebra 1 (SV-1) if the CSVL fell between the medial walls of the LIV pedicles; SV-2 if between stable vertebra 1 and 3; and SV-3 if the CSVL did not touch the LIV. LIV was divided by rotation into: neutral vertebra 0 (NV-0) if the LIV was at or distal to the neutral vertebra; NV-1 if one vertebra proximal to the NV; NV-2 if two vertebrae proximal; and NV-3 if three vertebrae proximal to the NV. Results: The prevalence of adding-on (AO) or distal junctional kyphosis (DJK) at ultimate follow-up was 13.6%. Patients with AO or DJK had a higher rate of open triradiate cartilage, LIV not touching the CSVL, and more proximal to the NV (p < .05). Risk factors were SV-3 (39% vs. SV-2 14%, SV-1 9%, p < .05), NV-3 (35% vs. NV-2 9%, NV-1 6%, NV-0 12%, p = .000), open triradiate cartilage (43% vs. closed 13%, p < .05), lumbar C modifier (22% vs. B modifier 8%, A modifier 13%, p < .05), and Risser stage 0 (19% vs. 12% Risser 1-5, p < .05). Conclusion: The prevalence of AO or DJK at ultimate follow-up of PSSIF for AIS with LIV at L2 or above was 13.6%. Risk factors included the CSVL outside the LIV, LIV 3 or more proximal to the NV, open triradiate cartilage, lumbar C modifier, and Risser stage 0. Level of Evidence: Level IV.

Original languageEnglish (US)
JournalSpine Deformity
DOIs
StateAccepted/In press - Jan 1 2017
Externally publishedYes

Fingerprint

Thoracic Vertebrae
Scoliosis
Spine
Spinal Fusion
Kyphosis
Cartilage
Thorax

Keywords

  • Adolescent idiopathic scoliosis
  • Selection of levels
  • Spinal fusion

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Fischer, C. R., Lenke, L. G., Bridwell, K. H., Boachie-Adjei, O., Gupta, M., & Kim, Y. J. (Accepted/In press). Optimal Lowest Instrumented Vertebra for Thoracic Adolescent Idiopathic Scoliosis. Spine Deformity. https://doi.org/10.1016/j.jspd.2017.10.002

Optimal Lowest Instrumented Vertebra for Thoracic Adolescent Idiopathic Scoliosis. / Fischer, Charla R.; Lenke, Lawrence G.; Bridwell, Keith H.; Boachie-Adjei, Oheneba; Gupta, Munish; Kim, Yongjung J.

In: Spine Deformity, 01.01.2017.

Research output: Contribution to journalArticle

Fischer, Charla R. ; Lenke, Lawrence G. ; Bridwell, Keith H. ; Boachie-Adjei, Oheneba ; Gupta, Munish ; Kim, Yongjung J. / Optimal Lowest Instrumented Vertebra for Thoracic Adolescent Idiopathic Scoliosis. In: Spine Deformity. 2017.
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abstract = "Study Design: Retrospective cohort chart review. Objective: To determine the optimal lowest instrumented vertebra (LIV) following posterior segmental spinal instrumented fusion (PSSIF) of thoracic adolescent idiopathic scoliosis (AIS) with LIV at L2 or above. Summary of Background Data: Few studies evaluate the optimal LIV based on rotation or center sacral vertical line (CSVL). Methods: A radiographic assessment of 544 thoracic major AIS patients (average age 14.7 years) with minimum 2 years' follow-up (average 4.1 years) after PSSIF was performed. The LIV was divided by CSVL: stable vertebra 1 (SV-1) if the CSVL fell between the medial walls of the LIV pedicles; SV-2 if between stable vertebra 1 and 3; and SV-3 if the CSVL did not touch the LIV. LIV was divided by rotation into: neutral vertebra 0 (NV-0) if the LIV was at or distal to the neutral vertebra; NV-1 if one vertebra proximal to the NV; NV-2 if two vertebrae proximal; and NV-3 if three vertebrae proximal to the NV. Results: The prevalence of adding-on (AO) or distal junctional kyphosis (DJK) at ultimate follow-up was 13.6{\%}. Patients with AO or DJK had a higher rate of open triradiate cartilage, LIV not touching the CSVL, and more proximal to the NV (p < .05). Risk factors were SV-3 (39{\%} vs. SV-2 14{\%}, SV-1 9{\%}, p < .05), NV-3 (35{\%} vs. NV-2 9{\%}, NV-1 6{\%}, NV-0 12{\%}, p = .000), open triradiate cartilage (43{\%} vs. closed 13{\%}, p < .05), lumbar C modifier (22{\%} vs. B modifier 8{\%}, A modifier 13{\%}, p < .05), and Risser stage 0 (19{\%} vs. 12{\%} Risser 1-5, p < .05). Conclusion: The prevalence of AO or DJK at ultimate follow-up of PSSIF for AIS with LIV at L2 or above was 13.6{\%}. Risk factors included the CSVL outside the LIV, LIV 3 or more proximal to the NV, open triradiate cartilage, lumbar C modifier, and Risser stage 0. Level of Evidence: Level IV.",
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AU - Fischer, Charla R.

AU - Lenke, Lawrence G.

AU - Bridwell, Keith H.

AU - Boachie-Adjei, Oheneba

AU - Gupta, Munish

AU - Kim, Yongjung J.

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N2 - Study Design: Retrospective cohort chart review. Objective: To determine the optimal lowest instrumented vertebra (LIV) following posterior segmental spinal instrumented fusion (PSSIF) of thoracic adolescent idiopathic scoliosis (AIS) with LIV at L2 or above. Summary of Background Data: Few studies evaluate the optimal LIV based on rotation or center sacral vertical line (CSVL). Methods: A radiographic assessment of 544 thoracic major AIS patients (average age 14.7 years) with minimum 2 years' follow-up (average 4.1 years) after PSSIF was performed. The LIV was divided by CSVL: stable vertebra 1 (SV-1) if the CSVL fell between the medial walls of the LIV pedicles; SV-2 if between stable vertebra 1 and 3; and SV-3 if the CSVL did not touch the LIV. LIV was divided by rotation into: neutral vertebra 0 (NV-0) if the LIV was at or distal to the neutral vertebra; NV-1 if one vertebra proximal to the NV; NV-2 if two vertebrae proximal; and NV-3 if three vertebrae proximal to the NV. Results: The prevalence of adding-on (AO) or distal junctional kyphosis (DJK) at ultimate follow-up was 13.6%. Patients with AO or DJK had a higher rate of open triradiate cartilage, LIV not touching the CSVL, and more proximal to the NV (p < .05). Risk factors were SV-3 (39% vs. SV-2 14%, SV-1 9%, p < .05), NV-3 (35% vs. NV-2 9%, NV-1 6%, NV-0 12%, p = .000), open triradiate cartilage (43% vs. closed 13%, p < .05), lumbar C modifier (22% vs. B modifier 8%, A modifier 13%, p < .05), and Risser stage 0 (19% vs. 12% Risser 1-5, p < .05). Conclusion: The prevalence of AO or DJK at ultimate follow-up of PSSIF for AIS with LIV at L2 or above was 13.6%. Risk factors included the CSVL outside the LIV, LIV 3 or more proximal to the NV, open triradiate cartilage, lumbar C modifier, and Risser stage 0. Level of Evidence: Level IV.

AB - Study Design: Retrospective cohort chart review. Objective: To determine the optimal lowest instrumented vertebra (LIV) following posterior segmental spinal instrumented fusion (PSSIF) of thoracic adolescent idiopathic scoliosis (AIS) with LIV at L2 or above. Summary of Background Data: Few studies evaluate the optimal LIV based on rotation or center sacral vertical line (CSVL). Methods: A radiographic assessment of 544 thoracic major AIS patients (average age 14.7 years) with minimum 2 years' follow-up (average 4.1 years) after PSSIF was performed. The LIV was divided by CSVL: stable vertebra 1 (SV-1) if the CSVL fell between the medial walls of the LIV pedicles; SV-2 if between stable vertebra 1 and 3; and SV-3 if the CSVL did not touch the LIV. LIV was divided by rotation into: neutral vertebra 0 (NV-0) if the LIV was at or distal to the neutral vertebra; NV-1 if one vertebra proximal to the NV; NV-2 if two vertebrae proximal; and NV-3 if three vertebrae proximal to the NV. Results: The prevalence of adding-on (AO) or distal junctional kyphosis (DJK) at ultimate follow-up was 13.6%. Patients with AO or DJK had a higher rate of open triradiate cartilage, LIV not touching the CSVL, and more proximal to the NV (p < .05). Risk factors were SV-3 (39% vs. SV-2 14%, SV-1 9%, p < .05), NV-3 (35% vs. NV-2 9%, NV-1 6%, NV-0 12%, p = .000), open triradiate cartilage (43% vs. closed 13%, p < .05), lumbar C modifier (22% vs. B modifier 8%, A modifier 13%, p < .05), and Risser stage 0 (19% vs. 12% Risser 1-5, p < .05). Conclusion: The prevalence of AO or DJK at ultimate follow-up of PSSIF for AIS with LIV at L2 or above was 13.6%. Risk factors included the CSVL outside the LIV, LIV 3 or more proximal to the NV, open triradiate cartilage, lumbar C modifier, and Risser stage 0. Level of Evidence: Level IV.

KW - Adolescent idiopathic scoliosis

KW - Selection of levels

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