Selection of Optimal Lower Instrumented Vertebra for Adolescent Idiopathic Scoliosis Surgery

Overview

Journal Neurospine

Date 2023 Oct 6

PMID 37798973

Authors

Seung-Ho Seo

Seung-Jae Hyun

Jae-Koo Lee

Yong Jae Cho

Dae Jean Jo

Jin Hoon Park

Ki-Jeong Kim

Affiliations

Soon will be listed here.

Abstract

Adolescent idiopathic scoliosis (AIS) affects approximately 2% of adolescents across all ethnicities. The objectives of surgery for AIS are to halt curve progression, correct the deformity in 3 dimensions, and preserve as many mobile spinal segments as possible, avoiding junctional complications. Despite ongoing development in algorithms and classification systems for the surgical treatment of AIS, there is still considerable debate about selecting the appropriate fusion level. In this study, we review the literature on fusion selection and present current concepts regarding the lower instrumented vertebra in the selection of the fusion level for AIS surgery.

Citing Articles

A mathematical model for estimating the intraoperative lowest instrumented vertebra (LIV) tilt angle using preoperative supine left side-bending (LSB) radiographs in adolescent idiopathic scoliosis (AIS) patients with lenke type 1 and 2 non-AR curves.

Kwan M, Lee S, Fam S, Tan Y, Ngan C, Chandirasegaran S Eur Spine J. 2024; 34(2):610-624.

PMID: 39738872 DOI: 10.1007/s00586-024-08602-1.

LIV selection in 'tweener' patients treated with magnetically controlled growing rods vs. posterior spinal fusion.

Yoshida B, Leonardi C, Valenzuela-Moss J, Andras L, Tetreault T, Emans J Spine Deform. 2024; .

PMID: 39674955 DOI: 10.1007/s43390-024-01019-2.

Postoperative Coronal Imbalance in Lenke 5C Adolescent Idiopathic Scoliosis: Evolution, Risk Factors, and Clinical Implications.

Fang Y, Li J, Hu Z, Zhu Z, Qiu Y, Liu Z Neurospine. 2024; 21(3):903-912.

PMID: 39363470 PMC: 11456952. DOI: 10.14245/ns.2448544.272.

Commentary on "Selection of Optimal Lower Instrumented Vertebra for Adolescent Idiopathic Scoliosis Surgery".

Deml M Neurospine. 2023; 20(3):808-809.

PMID: 37798974 PMC: 10562250. DOI: 10.14245/ns.2346938.469.

From the Editor-in-Chief: Featured Articles in the September 2023 Issue.

Han I Neurospine. 2023; 20(3):731-732.

PMID: 37798966 PMC: 10562214. DOI: 10.14245/ns.2346874.437.

References

Lander S, Thirukumaran C, Saleh A, Noble K, Menga E, Mesfin A . Long-Term Health-Related Quality of Life After Harrington Instrumentation and Fusion for Adolescent Idiopathic Scoliosis: A Minimum 40-Year Follow-up. J Bone Joint Surg Am. 2022; 104(11):995-1003. DOI: 10.2106/JBJS.21.00763. View

Lenke L, Betz R, Harms J, Bridwell K, Clements D, Lowe T . Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001; 83(8):1169-81. View

Hyun S, Lenke L, Kim Y, Bridwell K, Cerpa M, Blanke K . The Incidence of Adding-On or Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Treated by Anterior Spinal Fusion to L3 Was Significantly Higher Than by Posterior Spinal Fusion to L3. Neurospine. 2021; 18(3):457-463. PMC: 8497232. DOI: 10.14245/ns.2142182.091. View

Lee C, Ha J, Hwang C, Lee D, Kim T, Cho J . Is it enough to stop distal fusion at L3 in adolescent idiopathic scoliosis with major thoracolumbar/lumbar curves?. Eur Spine J. 2016; 25(10):3256-3264. DOI: 10.1007/s00586-015-4373-4. View

Chang D, Yang J, Suk S, Suh S, Kim Y, Cho W . 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. Spine (Phila Pa 1976). 2016; 42(15):E890-E898. DOI: 10.1097/BRS.0000000000001998. View

Majd M, Holt R, Castro F . Selection of fusion levels in scoliosis surgery. J Spinal Disord Tech. 2003; 16(1):71-82. DOI: 10.1097/00024720-200302000-00012. View

Fischer C, Lenke L, Bridwell K, Boachie-Adjei O, Gupta M, Kim Y . Optimal Lowest Instrumented Vertebra for Thoracic Adolescent Idiopathic Scoliosis. Spine Deform. 2018; 6(3):250-256. DOI: 10.1016/j.jspd.2017.10.002. View

Matsumoto M, Watanabe K, Hosogane N, Kawakami N, Tsuji T, Uno K . Postoperative distal adding-on and related factors in Lenke type 1A curve. Spine (Phila Pa 1976). 2012; 38(9):737-44. DOI: 10.1097/BRS.0b013e318279b666. View

Sarlak A, Atmaca H, Kim W, Musaoglu R, Tosun B . Radiographic features of the Lenke 1A curves to help to determine the optimum distal fusion level selection. Spine (Phila Pa 1976). 2011; 36(19):1592-9. DOI: 10.1097/BRS.0b013e3181f54f7f. View

10.

Takahashi J, Newton P, Ugrinow V, Bastrom T . Selective thoracic fusion in adolescent idiopathic scoliosis: factors influencing the selection of the optimal lowest instrumented vertebra. Spine (Phila Pa 1976). 2011; 36(14):1131-41. DOI: 10.1097/BRS.0b013e3182053d19. View

11.

Kim S, Lim D, Kim J, Kim J, Um K, Ahn S . Determination of the distal fusion level in the management of thoracolumbar and lumbar adolescent idiopathic scoliosis using pedicle screw instrumentation. Asian Spine J. 2015; 8(6):804-12. PMC: 4278987. DOI: 10.4184/asj.2014.8.6.804. View

12.

Szwed A, Kolban M, Jaloszewski M . Results of SpineCor dynamic bracing for idiopathic scoliosis. Ortop Traumatol Rehabil. 2009; 11(5):427-32. View

13.

Ahonen M, Syvanen J, Helenius L, Mattila M, Perokorpi T, Diarbakerli E . Back Pain and Quality of Life 10 Years After Segmental Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2023; 48(10):665-671. DOI: 10.1097/BRS.0000000000004641. View

14.

Sarwahi V, Hasan S, Wendolowski S, Visahan K, Atlas A, Galina J . A Newer Way of Determining LIV in AIS Patients: Rotation of the Touched Vertebrae. Spine (Phila Pa 1976). 2022; 47(18):1321-1327. DOI: 10.1097/BRS.0000000000004378. View

15.

Sun Z, Qiu G, Zhao Y, Wang Y, Zhang J, Shen J . Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra+1?. Eur Spine J. 2014; 23(6):1251-7. DOI: 10.1007/s00586-014-3276-0. View

16.

Ovadia D . Classification of adolescent idiopathic scoliosis (AIS). J Child Orthop. 2014; 7(1):25-8. PMC: 3566250. DOI: 10.1007/s11832-012-0459-2. View

17.

Newton P, Faro F, Lenke L, Betz R, Clements D, Lowe T . Factors involved in the decision to perform a selective versus nonselective fusion of Lenke 1B and 1C (King-Moe II) curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2003; 28(20):S217-23. DOI: 10.1097/01.BRS.0000092461.11181.CD. View

18.

Fischer C, Kim Y . Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy. Eur Spine J. 2011; 20(7):1048-57. PMC: 3176697. DOI: 10.1007/s00586-011-1730-9. View

19.

Ding R, Liang J, Qiu G, Shen J, Li Z . Evaluation of quality of life in adolescent idiopathic scoliosis with different distal fusion level: a comparison of L3 versus L4. J Spinal Disord Tech. 2014; 27(5):E155-61. DOI: 10.1097/BSD.0000000000000073. View

20.

Weinstein S, Dolan L, Cheng J, Danielsson A, Morcuende J . Adolescent idiopathic scoliosis. Lancet. 2008; 371(9623):1527-37. DOI: 10.1016/S0140-6736(08)60658-3. View