TY - JOUR
T1 - Including the stable sagittal vertebra in the fusion for adolescent idiopathic scoliosis reduces the risk of distal junctional kyphosis in Lenke 1–3 B and C curves
AU - Harms Study Group
AU - Marciano, Gerard
AU - Ball, Jacob
AU - Matsumoto, Hiroko
AU - Roye, Benjamin
AU - Lenke, Lawrence
AU - Newton, Peter
AU - Vitale, Michael
AU - Buckland, Aaron
AU - Samdani, Amer
AU - Jain, Amit
AU - Lonner, Baron
AU - Roye, Benjamin
AU - Yaszay, Burt
AU - Reilly, Chris
AU - Hedequist, Daniel
AU - Sucato, Daniel
AU - Clements, David
AU - Miyanji, Firoz
AU - Shufflebarger, Harry
AU - Flynn, Jack
AU - Asghar, Jahangir
AU - Mac Thiong, Jean Marc
AU - Pahys, Joshua
AU - Harms, Juergen
AU - Bachmann, Keith
AU - Lenke, Larry
AU - Abel, Mark
AU - Glotzbecker, Michael
AU - Kelly, Michael
AU - Marks, Michelle
AU - Gupta, Munish
AU - Fletcher, Nicholas
AU - Cahill, Patrick
AU - Sponseller, Paul
AU - Gabos, Peter
AU - Sturm, Peter
AU - Betz, Randal
AU - Lehman, Ron
AU - Parent, Stefan
AU - George, Stephen
AU - Hwang, Steven
AU - Shah, Suken
AU - Errico, Tom
AU - Upasani, Vidyadhar
N1 - Publisher Copyright:
© 2021, Scoliosis Research Society.
PY - 2021/5
Y1 - 2021/5
N2 - Purpose: The selection of lowest instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) is determined by coronal and sagittal plane indicators. Failure to properly select the LIV can lead to suboptimal outcomes and the need for revision surgery. A subset of patients have discordant coronal last touched vertebra (cLTV) and stable sagittal vertebra (SSV) which complicates the choice of LIV. The purpose of this study is to report the incidence of discordant cLTV and SSV when choosing LIV and investigate the association between length of fusion and patient-reported outcomes (PROs) and distal junctional kyphosis (DJK). Methods: This retrospective multicenter cohort study included AIS patients with discordant pre-operative cLTV and SSV. Patients fused only to include the proximal cLTV were compared to patients fused to include the distal SSV. Primary outcomes included DJK and PROs measured by SRS-22. Results: Eight hundred and fifty-six patients were identified of which 114 (13.3%) had discordant SSV and cLTV. The DJK incidence was 7.7% and 45.5% in patients fused to include the SSV versus short of the SSV, respectively. Lenke Modifier type B and C patients with fusions short of the SSV had a 9.2 times increased risk of developing DJK at 2 years compared to patients with fusions including the SSV (95% CI 2.8, 29.7; p < 0.001). However, patients with fusions short of the SSV and no evidence of DJK were 9.2 times more likely to have improvement in the SRS-22 pain domain compared to patients with fusions including the distal SSV (95% CI 1.1, 77.4; p = 0.042) Conclusion: Patients fused short of the SSV are at significant risk for the development of DJK at 2 years post-operatively. However, patients with shorter fusions were more likely to have an improvement in their pain as measured by patient-reported outcomes than patients with longer fusions.
AB - Purpose: The selection of lowest instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) is determined by coronal and sagittal plane indicators. Failure to properly select the LIV can lead to suboptimal outcomes and the need for revision surgery. A subset of patients have discordant coronal last touched vertebra (cLTV) and stable sagittal vertebra (SSV) which complicates the choice of LIV. The purpose of this study is to report the incidence of discordant cLTV and SSV when choosing LIV and investigate the association between length of fusion and patient-reported outcomes (PROs) and distal junctional kyphosis (DJK). Methods: This retrospective multicenter cohort study included AIS patients with discordant pre-operative cLTV and SSV. Patients fused only to include the proximal cLTV were compared to patients fused to include the distal SSV. Primary outcomes included DJK and PROs measured by SRS-22. Results: Eight hundred and fifty-six patients were identified of which 114 (13.3%) had discordant SSV and cLTV. The DJK incidence was 7.7% and 45.5% in patients fused to include the SSV versus short of the SSV, respectively. Lenke Modifier type B and C patients with fusions short of the SSV had a 9.2 times increased risk of developing DJK at 2 years compared to patients with fusions including the SSV (95% CI 2.8, 29.7; p < 0.001). However, patients with fusions short of the SSV and no evidence of DJK were 9.2 times more likely to have improvement in the SRS-22 pain domain compared to patients with fusions including the distal SSV (95% CI 1.1, 77.4; p = 0.042) Conclusion: Patients fused short of the SSV are at significant risk for the development of DJK at 2 years post-operatively. However, patients with shorter fusions were more likely to have an improvement in their pain as measured by patient-reported outcomes than patients with longer fusions.
KW - Adolescent idiopathic scoliosis
KW - Distal junctional kyphosis
KW - Posterior spinal fusion
KW - Stable sagittal vertebra
UR - http://www.scopus.com/inward/record.url?scp=85105764585&partnerID=8YFLogxK
U2 - 10.1007/s43390-020-00259-2
DO - 10.1007/s43390-020-00259-2
M3 - Article
C2 - 33400234
AN - SCOPUS:85105764585
SN - 2212-134X
VL - 9
SP - 733
EP - 741
JO - Spine Deformity
JF - Spine Deformity
IS - 3
ER -