Importance of Distal Fusion Level in Major Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis Treated by Rod Derotation and Direct Vertebral Rotation Following Pedicle Screw Instrumentation

Dong Gune Chang, Jae Hyuk Yang, Se Il Suk, Seung Woo Suh, Young Hoon Kim, Woojin Cho, Yeon Seok Jeong, Jin Hyok Kim, Kee Yong Ha, Jung Hee Lee

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STUDY DESIGN.: A retrospective comparative study. OBJECTIVE.: To analyze the exact distal fusion level in the treatment of major thoracolumbar and lumbar (TL/L) adolescent idiopathic scoliosis (AIS) using rod derotation (RD) and direct vertebral rotation (DVR) following pedicle screw instrumentation (PSI). SUMMARY OF BACKGROUND DATA.: Proper determination of distal fusion level is a very important factor in deformity correction and preservation of motion segments in the treatment of major TL/L AIS. METHODS.: AIS patients with major TL/L curves (n?=?64) treated by PSI with RD and DVR methods with a minimum 2-year follow-up were divided into AL3 (flexible) and BL3 (rigid) according to the flexibility and rotation by preoperative bending radiographs. RESULTS.: There was no significant difference in TL/L (major) curve between the AL3 and BL3 groups postoperatively (P?=?0.933) and at the last follow-up (P?=?0.144). Additionally, there was no significant difference in thoracic (minor) and compensatory (caudal) curve postoperatively (thoracic curve: P?=?0.828, compensatory curve: P?=?0.976); however, there was a significant difference in compensatory (caudal) curve at the last follow-up (P?=?0.041). The overall prevalence of unsatisfactory results was 28.1% (18/64 patients), and the prevalence was 15.2% (7/46) in the AL3 group and 61.1% (11/18) in the BL3 group, which was significantly different (P?<?0.05). CONCLUSIONS.: LIV would be selected at L3 (EV) when the curve is flexible; L3 crosses CSVL with a rotation of less than grade II in preoperative bending radiographs. However, if the curve is rigid, LIV should be extended to L4 (EV?+?1) in order to prevent the adding-on phenomenon in the treatment of major TL/L AIS using RD and DVR following PSI.Level of Evidence: 4

Original languageEnglish (US)
StateAccepted/In press - Nov 22 2016


ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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