Selection of fusion levels in scoliosis surgery.

Fusion levels are selected with the goal of having a balanced physiologic spine on the postoperative films. We have proposed an algorithm for selecting fusion levels based on the King-Moe scoliosis classification scheme and the flexibility of a compensatory curve. We propose the acronym TEAMS as a pneumonic. Curve type defines the region of the spine to be fused. The ends of the Cobb measurement around the region are the temporary endpoints. The endpoints are extended to avoid an apex due to the sagittal or frontal planes. The mobile disc is defined at the caudal end of the fusion area. Finally, the bending films, traction films, or intraoperative films are used to define the stable zone of Harrington that must contain the ends of the fusion mass. This scheme yields a simple, easily taught algorithm that results in reproducible endpoints for scoliosis fusion.