Choice of Lowest Instrumented Vertebras for Lenke I Adolescent Idiopathic Scoliosis Orthopedics
Journal of Surgery
Volume 4, Issue 6, December 2016, Pages: 134-140
Received: Dec. 22, 2016;
Accepted: Dec. 30, 2016;
Published: Jan. 21, 2017
Views 2722 Downloads 88
Zhisheng Ji, Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Sida Chen, Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Guowei Zhang, Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Yuhao Yang, Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Yaozhong Liang, Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Hongsheng Lin, Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
To discuss the impact of different lowest instrumented vertebras on the effect of posterior spinal pedicle screw-rod orthopedics for treatment of Lenke I adolescent idiopathic scoliosis. 45 patients with adolescent idiopathic scoliosis (AIS) who received posterior pedicle screw-rod orthopedics from July 2011 to September 2015 were analyzed retrospectively. All patients were divided into touched vertebra group (n=21 cases; 6 M and 15 F) and stable vertebra group (n=24 cases; 7 M and 17 F) according to the choice of different lowest instrumented vertebras. The indexes of the coronal and sagittal spinal imaging before and after operation as well as in the last follow-up were analyzed and SRS-22 questionnaire was performed to evaluate the curative effect. Through a 6-36-month follow-up visit, no significant difference was found in the pre-operative indexes (Cobb angle and pre-operative TS, SVA, TK and LL) of the coronal and sagittal spinal imaging between the two groups (P>0.05). Meanwhile, there was no statistical difference in the spinal coronal parameters (i.e., Cobb angle, TS, pre-operative thoracic-waist/waist scoliosis, pre-operative flexibility of thoracic scoliosis, correction rate and loss rate) after operation and in the last follow-up visit between the two groups (P>0.05). In touched vertebra group, the coronal spinal parameters (e.g., thoracic-waist/waist scoliosis) after operation and in the last follow-up visit were significantly higher than those of stable vertebra group (P<0.05) while there was no statistical difference in postoperative SVA between the two groups (P>0.05). In the aspect of fusion segments, the touched vertebra group saved one centrum relative to stable vertebra group (P<0.05). The postoperative SRS-22 scores for living quality of both groups were significantly decreased compared with the pre-operative, in which the score was decreased from the preoperative 51.0 to 29.0 in touched vertebra group and from 50.9 to 28.7 in stable vertebra group (both P<0.05), but both the pre- and post-operative scores were not significantly different between the two groups (P>0.05). In order to treat Lenke I AIS patients with posterior pedicle screw-rod orthopedics, touched vertebra should be used as lowest instrumented vertebra as it can not only obtain the similar therapeutic effect to stable vertebra, but also shorten the fixed segments.
Choice of Lowest Instrumented Vertebras for Lenke I Adolescent Idiopathic Scoliosis Orthopedics, Journal of Surgery.
Vol. 4, No. 6,
2016, pp. 134-140.
Lenke, L. G., R. R. Betz, J. Harms, K. H. Bridwell, D. H. Clements, T. G. Lowe, and K. Blanke, Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am, 2001, 83-A (8): 1169-81.
Weinstein, S. L., L. A. Dolan, J. C. Cheng, A. Danielsson, and J. A. Morcuende, Adolescent idiopathic scoliosis. Lancet, 2008, 371 (9623): 1527-37.
Korbel, K., M. Kozinoga, L. Stolinski, and T. Kotwicki, Scoliosis Research Society (SRS) Criteria and Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2008 Guidelines in Non-Operative Treatment of Idiopathic Scoliosis. Pol Orthop Traumatol, 2014, 79: 118-22.
Parent, S., P. O. Newton, and D. R. Wenger, Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing. Instr Course Lect, 2005, 54: 529-36.
Asher, M. A. and D. C. Burton, Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis, 2006, 1 (1): 2.
Kadoury, S., F. Cheriet, M. Beausejour, I. A. Stokes, S. Parent, and H. Labelle, A three-dimensional retrospective analysis of the evolution of spinal instrumentation for the correction of adolescent idiopathic scoliosis. Eur Spine J, 2009, 18 (1): 23-37.
Qin, X., W. Sun, L. Xu, Z. Liu, Y. Qiu, and Z. Zhu, Selecting the Last "Substantially" Touching Vertebra as Lowest Instrumented Vertebra in Lenke Type 1A Curve: Radiographic Outcomes With a Minimum of 2-year Follow-Up. Spine (Phila Pa 1976), 2016, 41 (12): E742-50.
Wang, Y., C. E. Bunger, Y. Zhang, and E. S. Hansen, Lowest instrumented vertebra selection in Lenke 3C and 6C scoliosis: what if we choose lumbar apical vertebra as distal fusion end? Eur Spine J, 2012, 21 (6): 1053-61.
Carreon, L. Y., C. H. Crawford, III, L. G. Lenke, D. J. Sucato, and S. D. Glassman, Optimal Lowest Instrumented Vertebra Selection for Posterior Instrumented Fusion of Lenke Type 5 and 6 Adolescent Idiopathic Scoliosis: Is There a Difference in Outcome Between L3 and L4? The Spine Journal, 13 (9): S38.
Salah, H., H. B. Elsebaie, and A. Ezz, Instrumenting Proximal to the Left Bending Stable Vertebra in Lenke IA and IB Adolescent Idiopathic Scoliosis Predicts Adding On: Poster #307. Spine Journal Meeting Abstracts, 2010:167.
Suk, S. I., J. H. Kim, S. S. Kim, J. J. Lee, and Y. T. Han, Thoracoplasty in thoracic adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2008, 33 (10): 1061-7.
Wang, Y., E. S. Hansen, K. Hoy, C. Wu, and C. E. Bunger, Distal adding-on phenomenon in Lenke 1A scoliosis: risk factor identification and treatment strategy comparison. Spine (Phila Pa 1976), 2011, 36 (14): 1113-22.
Cao, K., K. Watanabe, N. Kawakami, T. Tsuji, N. Hosogane, I. Yonezawa, M. Machida, M. Yagi, S. Kaneko, Y. Toyama, and M. Matsumoto, Selection of lower instrumented vertebra in treating Lenke type 2A adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2014, 39 (4): E253-61.