Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra+1?

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• 作者：Zhijian Sun (1)
  Guixing Qiu (1)
  Yu Zhao (1)
  Yipeng Wang (1)
  Jianguo Zhang (1)
  Jianxiong Shen (1)
  
• 关键词：Thoracolumbar/lumbar idiopathic scoliosis ; Lowest instrumented vertebra selection ; Lower ; end vertebra ; Lower ; end vertebra+1 ; Selective fusion
• 刊名：European Spine Journal
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：23
• 期：6
• 页码：1251-1257
• 全文大小：
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• 作者单位：Zhijian Sun (1)
  Guixing Qiu (1)
  Yu Zhao (1)
  Yipeng Wang (1)
  Jianguo Zhang (1)
  Jianxiong Shen (1)
  
  1. Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District Shuaifuyuan No. 1, Beijing, 100730, China
  
• ISSN：1432-0932

文摘

Purpose To determine fusion necessity to one level below lower-end vertebra (LEV+1) in selective posterior fusion of moderate thoracolumbar/lumbar (TL/L) idiopathic scoliosis. Methods A total of 37 patients with moderate TL/L idiopathic scoliosis (Cobb angle of TL/L curve between 30° and 60°) were identified and three patients with TL/L curve Cobb angle more than 60° were excluded. And the follow-up period was at least 2?years. Lowest instrumented vertebra (LIV) was one level proximal to LEV in three patients, LEV in 22 patients and LEV+1 in 12 patients. The three patients with TL/L Cobb angle more than 60° were all fused to LEV+1. Clinical and various radiographic measurements were collected before surgery, post-surgery and during last follow-up, and analytical comparisons were made between LIV?=?LEV patients and LIV?=?LEV+1 patients. Results No significant difference was observed regarding clinical and radiographic parameters between LEV group and LEV+1 group preoperatively except LIV disc angle and LIV translation. The correction rate of unfused thoracic curve and TL/L curve was 52.7 and 79.9?% in LEV group and 52.5 and 83.7?% in LEV+1 group at the last follow-up, indicating no significant difference (P?=?0.976 and P?=?0.415, respectively). Coronal balance and sagittal alignments were also comparable between the two groups. LIV translation was slightly less in LEV+1 group (P?=?0.028) at the last follow-up on the basis that LEV+1 was less translated than LEV preoperatively. Conclusions Our analysis almost showed no benefit for fusing to LEV+1 in moderate TL/L idiopathic scoliosis patients undergoing posterior selective fusion with pedicle screws. For patients with TL/L Cobb angle more than 60°, the distal fusion level probably needs to be LEV+1.