TY - JOUR
T1 - A Newer Way of Determining LIV in AIS Patients
T2 - Rotation of the Touched Vertebrae
AU - Sarwahi, Vishal
AU - Hasan, Sayyida
AU - Wendolowski, Stephen
AU - Visahan, Keshin
AU - Atlas, Aaron
AU - Galina, Jesse
AU - Lo, Yungtai
AU - Amaral, Terry
AU - Rao, Himanshu
AU - Thornhill, Beverly
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/9/15
Y1 - 2022/9/15
N2 - Study Design. A retrospective review. Objective. The objective of this study was to determine whether fusing to touched vertebra (TV) on prone x-rays (XRs) with minimal rotation (Gd 0/1) allow for shorter fusion with optimal correction. Summary of Background. Previous studies have shown risk of "adding on" when TV is not selected as lowest instrumented vertebra (LIV). Fusion proximal to TV leads to suboptimal results but fusing to TV on standing XRs can result in longer fusions. On lying down XRs, TV moves proximally, and its rotation decreases by a grade. Methods. TV patients with minimal rotation were selected on prone (TVP) or standing XRs (TVS). Patients fused to rotated (Gd 2+) TV on standing or prone XRs were considered touched vertebra rotated (TVR). In the non-TV (NTV) group, LIV was fused proximal to TV. Disk wedging ≥5° determined risk of "adding-on." To compare patients fused to minimally rotated TV, to those that were not, patients in group A (TVP + TVS) were compared with group B (TVR + NTV). In part II: TVP, TVS, TVR, and NTV patients were compared. Subanalysis compared levels saved as the difference between predicted and real LIV in TVP and TVS patients. Another subanalysis was carried out for Lenke 1+2 and Lenke 3, 4, 5. In part III: XRs of nonoperative adolescents idiopathic scoliosis patients with Cobb <30 and Risser 4/5 were analyzed to determine "acceptable" end vertebra tilt and disc wedging and served as controls. Results. There were a significantly greater number of patients in group B patients(TVR + NTV) with final disk wedging ≥5°, final LIV translation ≥1 and ≥2 cm (P<0.001). Utilizing prone XRs in TVP saved average 1 level, and 1.2 levels in TVS patients. TVP patients also had similar LIV tilt, disk wedging and coronal balance(P>0.05) to controls. Conclusion. Choosing minimally rotated (Gd 0/1) TV on prone XR saves levels without sacrificing radiographic outcomes.
AB - Study Design. A retrospective review. Objective. The objective of this study was to determine whether fusing to touched vertebra (TV) on prone x-rays (XRs) with minimal rotation (Gd 0/1) allow for shorter fusion with optimal correction. Summary of Background. Previous studies have shown risk of "adding on" when TV is not selected as lowest instrumented vertebra (LIV). Fusion proximal to TV leads to suboptimal results but fusing to TV on standing XRs can result in longer fusions. On lying down XRs, TV moves proximally, and its rotation decreases by a grade. Methods. TV patients with minimal rotation were selected on prone (TVP) or standing XRs (TVS). Patients fused to rotated (Gd 2+) TV on standing or prone XRs were considered touched vertebra rotated (TVR). In the non-TV (NTV) group, LIV was fused proximal to TV. Disk wedging ≥5° determined risk of "adding-on." To compare patients fused to minimally rotated TV, to those that were not, patients in group A (TVP + TVS) were compared with group B (TVR + NTV). In part II: TVP, TVS, TVR, and NTV patients were compared. Subanalysis compared levels saved as the difference between predicted and real LIV in TVP and TVS patients. Another subanalysis was carried out for Lenke 1+2 and Lenke 3, 4, 5. In part III: XRs of nonoperative adolescents idiopathic scoliosis patients with Cobb <30 and Risser 4/5 were analyzed to determine "acceptable" end vertebra tilt and disc wedging and served as controls. Results. There were a significantly greater number of patients in group B patients(TVR + NTV) with final disk wedging ≥5°, final LIV translation ≥1 and ≥2 cm (P<0.001). Utilizing prone XRs in TVP saved average 1 level, and 1.2 levels in TVS patients. TVP patients also had similar LIV tilt, disk wedging and coronal balance(P>0.05) to controls. Conclusion. Choosing minimally rotated (Gd 0/1) TV on prone XR saves levels without sacrificing radiographic outcomes.
KW - AIS
KW - LIV
KW - radiographic imaging
UR - http://www.scopus.com/inward/record.url?scp=85137127169&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85137127169&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004378
DO - 10.1097/BRS.0000000000004378
M3 - Article
C2 - 35913804
AN - SCOPUS:85137127169
SN - 0362-2436
VL - 47
SP - 1321
EP - 1327
JO - Spine
JF - Spine
IS - 18
ER -