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

STUDY DESIGN.A retrospective comparative study. OBJECTIVE.The aim of this study was 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...

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Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2017-08, Vol.42 (15), p.E890-E898
Main Authors: Chang, Dong-Gune, Yang, Jae Hyuk, Suk, Se-Il, Suh, Seung-Woo, Kim, Young-Hoon, Cho, Woojin, Jeong, Yeon-Seok, Kim, Jin-Hyok, Ha, Kee-Yong, Lee, Jung-Hee
Format: Article
Language:English
Subjects:
Adolescent
Female
Follow-Up Studies
Humans
Lumbar Vertebrae - diagnostic imaging
Lumbar Vertebrae - surgery
Male
Pedicle Screws - trends
Retrospective Studies
Rotation
Scoliosis - diagnostic imaging
Scoliosis - surgery
Spinal Fusion - instrumentation
Spinal Fusion - trends
Thoracic Vertebrae - diagnostic imaging
Thoracic Vertebrae - surgery
Treatment Outcome
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Summary:STUDY DESIGN.A retrospective comparative study. OBJECTIVE.The aim of this study was 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). In addition, there was no significant difference in thoracic (minor) and compensatory (caudal) curve postoperatively (thoracic curveP = 0.828, compensatory curveP = 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 
ISSN:0362-2436
1528-1159
DOI:10.1097/BRS.0000000000001998