Asian Spine J.  2014 Dec;8(6):804-812. 10.4184/asj.2014.8.6.804.

Determination of the Distal Fusion Level in the Management of Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis Using Pedicle Screw Instrumentation

Affiliations
  • 1Department of Orthopaedics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 2Seoul Spine Institute, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. scd25@paik.ac.kr

Abstract

STUDY DESIGN: A retrospective study. PURPOSE: To determine the exact distal fusion level in the management of thoracolumbar/lumbar adolescent idiopathic scoliosis (TL/L AIS) using pedicle screw instrumentation (PSI). OVERVIEW OF LITERATURE: The selection of distal fusion level remains controversial in TL/L AIS.
METHODS
Radiographic parameters of 66 TL/L AIS patients were analyzed. The patients were grouped according to the distal fusion level; L3 group (fusion to L3, n=58) and L4 group (fusion to L4, n=8). The L3 group was subdivided into L3A (L3 crosses the mid-sacral line with rotation of less than grade II, n=33) and L3B (L3 does not cross the mid-sacral line or rotation is grade II or more, n=25) based on both bending radiographs. All of the patients in the L4 group had the same location and rotation of L3 in bending films as that of patients in the L3B group. An unsatisfactory result was defined as a lowest instrumented vertebral tilt (LIVT) of more than 10degrees or coronal balance of more than 15 mm.
RESULTS
Among the 3 groups, there was a significantly lesser correction in the TL/L curve and LIVT in the L3B group. Unsatisfactory results were obtained in 3 patients (9.1%) of the L3A group, in 15 patients (68.2%) of the L3B group, and in 1 patient (12.5%) of the L4 group with a significant difference.
CONCLUSIONS
In TL/L AIS treatment with PSI, the curve can be fused to L3 with favorable radiographic outcomes when L3 crosses the mid-sacral line with rotation of less than grade II in bending films. Otherwise, fusion has to be extended to L4.

Keyword

Scoliosis; Adolescent; Spinal fusion; Instrumentation

MeSH Terms

Adolescent*
Humans
Retrospective Studies
Scoliosis*
Spinal Fusion
Full Text Links
  • ASJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr