J-L Clément1, F Solla2, A Tran2, C Morin3, W Lakhal4, J Sales de Gauzy5, J Leroux6, J-M Gennari7, F-H Parent8, G Kreichati9, S Wolf10, I Obeid11. 1. Hôpitaux pédiatriques de Nice, CHU Lenval, 57, avenue de la Californie, 06200 Nice, France. Electronic address: clement.jluc@wanadoo.fr. 2. Hôpitaux pédiatriques de Nice, CHU Lenval, 57, avenue de la Californie, 06200 Nice, France. 3. Institut Calot, rue du Dr-Calot, 68608 Berck-sur-Mer, France. 4. Hôpital Clocheville, 49, boulevard Béranger, 37000 Tours, France. 5. Hôpital d'enfants, 330, avenue de Grande-Bretagne, 31300 Toulouse, France. 6. Hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. 7. Hôpital Nord, chemin des Bourrely, 13045 Marseille, France. 8. Centre du rachis, 6, rue de Belliniere, 49800 Trelaze, France. 9. Hôtel-Dieu de France Hospital, boulevard Alfred-Naccache, Achrafié, Beirut, Lebanon. 10. Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France. 11. Hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
Abstract
BACKGROUND: Tilt of the First Distal Uninstrumented Vertebra (FDUV) reflects changes in the main curve and compensatory lumbar curve after posterior fusion to treat thoracic Adolescent Idiopathic Scoliosis (AIS). HYPOTHESIS: FDUV tilt 5 years or more post-fusion depends chiefly on reduction of the main curve and on other factors such as selection of the last instrumented vertebra. MATERIAL AND METHOD: A multicenter retrospective cohort of 182 patients with Lenke 1 or 2 AIS treated with posterior instrumentation and followed up for a mean of 8 years and a minimum of 5 years was studied. The patients were divided into two groups based on whether tilt of the upper endplate of the FDUV was ≤5° or >5°at last follow-up. Variables associated with tilt were identified by multiple logistic regression. RESULTS: Six variables were significantly associated with FDUVtilt: percentage of correction at last follow-up, correction loss, lumbar modifier B, number of instrumented vertebrae, inclusion within the instrumentation of the distal neutral vertebra, and inclusion within the instrumentation of the lowest vertebra intersected by the central sacral vertical line. DISCUSSION AND CONCLUSION: The main variables associated with FDUVtilt ≤5° were a final correction percentage ≥60% and absence of correction loss between the postoperative period and last follow-up. Given the stable reduction provided by contemporary instrumentations, we recommend selective thoracic fusion of Lenke 1 or 2 AIS with lumbar modifiers A, B, and C. The lowest instrumented vertebra should be either the neutral vertebra or the vertebra intersected by the central sacral vertical line if it is distal to the neutral vertebra. LEVEL OF EVIDENCE IV: Retrospective multicenter study.
BACKGROUND: Tilt of the First Distal Uninstrumented Vertebra (FDUV) reflects changes in the main curve and compensatory lumbar curve after posterior fusion to treat thoracic Adolescent Idiopathic Scoliosis (AIS). HYPOTHESIS: FDUV tilt 5 years or more post-fusion depends chiefly on reduction of the main curve and on other factors such as selection of the last instrumented vertebra. MATERIAL AND METHOD: A multicenter retrospective cohort of 182 patients with Lenke 1 or 2 AIS treated with posterior instrumentation and followed up for a mean of 8 years and a minimum of 5 years was studied. The patients were divided into two groups based on whether tilt of the upper endplate of the FDUV was ≤5° or >5°at last follow-up. Variables associated with tilt were identified by multiple logistic regression. RESULTS: Six variables were significantly associated with FDUVtilt: percentage of correction at last follow-up, correction loss, lumbar modifier B, number of instrumented vertebrae, inclusion within the instrumentation of the distal neutral vertebra, and inclusion within the instrumentation of the lowest vertebra intersected by the central sacral vertical line. DISCUSSION AND CONCLUSION: The main variables associated with FDUVtilt ≤5° were a final correction percentage ≥60% and absence of correction loss between the postoperative period and last follow-up. Given the stable reduction provided by contemporary instrumentations, we recommend selective thoracic fusion of Lenke 1 or 2 AIS with lumbar modifiers A, B, and C. The lowest instrumented vertebra should be either the neutral vertebra or the vertebra intersected by the central sacral vertical line if it is distal to the neutral vertebra. LEVEL OF EVIDENCE IV: Retrospective multicenter study.
Keywords:
Adolescent idiopathic scoliosis; Angulation of the first non-instrumented vertebra; Last touched vertebra; Loss of correction; Lowest instrumented vertebra; Posterior fusion
Authors: Federico Solla; Walid Lakhal; Christian Morin; Jerome Sales de Gauzy; Gaby Kreichati; Ibrahim Obeid; Stéphane Wolff; Joël Lechevallier; Henry F Parent; Jean-Luc Clément; Carlo M Bertoncelli Journal: Eur J Orthop Surg Traumatol Date: 2021-06-18