The Impact of the Lowest Instrumented Vertebra on the Correction of the Minor Curve During Selective Fusion in Patients With Adolescent Idiopathic Scoliosis.
Max Prost, Philip Denz, Joachim Windolf, Markus Rafael Konieczny
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Abstract
Study design: Retrospective single-center data analysis.
Objective: The aim of this investigation was to give advises for choosing the LIV in selective fusion to reach the best correction of the minor curve and sagittal profile.
Summary of background data: Scoliotic curves can be classified as structural or nonstructural. If selective fusion is performed, the nonstructural curves are not instrumented. The choice of the lowest instrumented vertebra (LIV) and the impact of different levels of the LIV on the correction of the minor curve in the frontal profile and on the sagittal balance is under debate.
Methods: Forty-seven consecutive patients treated by posterior instrumented fusion were included in this retrospective investigation. Impact of the level of the LIV with regard to distance to end vertebra (EV), to the stable vertebra (StV), to the sagittal infliction point (IP), and to the apex of the lumbar lordosis on the correction of the minor curve was analyzed.
Results: Distance of LIV to EV was significant with regard to correction of the minor curve if it was more than 5 levels (P<0.001). Distance of LIV to StV was significant with regard to correction of the minor curve if it was more than 4 levels (P<0.01). Distance of LIV to IP was significant with regard to correction of the minor curve if it was more than 2 levels (P<0.01).
Conclusions: Choosing a LIV that was more than 2 levels higher or lower than the sagittal infliction point showed a significantly higher correction of the minor curve. We therefore recommend to keep that distance when LIV is chosen.
研究设计回顾性单中心数据分析：本研究旨在为选择性融合中的LIV选择提供建议，以达到最佳的小曲线矫正和矢状轮廓矫正效果：脊柱侧弯可分为结构性和非结构性两种。如果进行选择性融合，非结构性脊柱侧弯将不进行器械治疗。关于最低器械椎体（LIV）的选择，以及不同水平的LIV对矫正正面小曲线和矢状平衡的影响，目前正在讨论之中：本次回顾性调查共纳入了 47 名接受后路器械融合治疗的连续患者。分析了 LIV 水平与椎体末端 (EV)、稳定椎体 (StV)、矢状突点 (IP) 和腰椎前凸顶点的距离对矫正小弯的影响：结果：LIV到EV的距离如果超过5级（PC结论：LIV到EV的距离超过5级对小弯矫正有显著影响：如果选择的 LIV 比矢状线诱发点高出或低出两级以上，则对小弯度的矫正效果明显更高。因此，我们建议在选择 LIV 时保持这一距离。
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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