Lee Phillips1,2, Burt Yaszay3, Tracey P Bastrom4, Suken A Shah5, Baron S Lonner6, Firoz Miyanji7, Amer F Samdani8, Stefan Parent9, Jahangir Asghar10, Patrick J Cahill11, Peter O Newton4. 1. Children's Orthopaedics and Scoliosis Surgery Associates, Saint Petersburg, FL, USA. 2. University of South Florida Orthopaedics, Tampa, FL, USA. 3. Rady Children's Hospital, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA. byaszay.rady@gmail.com. 4. Rady Children's Hospital, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA. 5. Alfred I. duPont Hospital for Children, Wilmington, DE, USA. 6. Scoliosis and Spine Associates, New York, NY, USA. 7. British Columbia Children's Hospital, Vancouver, BC, Canada. 8. Shriner's Hospital for Children, Philadelphia, PA, USA. 9. Sainte-Justine University Hospital Center, Montreal, QC, Canada. 10. Nicklaus Children's Hospital, Miami, FL, USA. 11. Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Abstract
PURPOSE: Determining whether to fuse a Lenke 5 curve to L3 or to L4 is often a difficult decision. The purpose of this study was to determine preoperative variables predictive of an "ideal" or "less than ideal" outcome for Lenke 5 curves instrumented to L3. METHODS: A multicentre registry of adolescent idiopathic scoliosis patients was queried for surgically treated Lenke 5 curves with a lowest instrumented vertebra (LIV) of L3 and minimum 2 years of follow-up. Five seasoned surgeons qualitatively rated the 2-year postoperative images as "ideal" or "less than ideal" with respect to correction and alignment. Preoperative and postoperative radiographic variables were compared between the two groups. Multivariate regression analysis was performed to determine variables most predictive of a "less than ideal" outcome. RESULTS: One hundred and thirty-nine patients met criteria. Twenty-three were considered "less than ideal" by ≥ 3 surgeons; 81 were unanimously "ideal". Preoperatively, the "less than ideal" group had significantly stiffer curves, greater apical translation, and greater LIV angulation and translation. Multivariate regression found that preoperative L3 translation (p = 0.009) was the single most important predictor of a "less than ideal" outcome: < 3.5 cm consistently resulted in an "ideal" outcome, while > 3.5 cm risked a "less than ideal" result. CONCLUSION: While multiple variables are important in achieving an "ideal" outcome in Lenke 5 curves, this study found preoperative L3 translation was the most important predictor of success with an L3 translation < 3.5 cm being a potential threshold for selecting L3 as the LIV. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: Determining whether to fuse a Lenke 5 curve to L3 or to L4 is often a difficult decision. The purpose of this study was to determine preoperative variables predictive of an "ideal" or "less than ideal" outcome for Lenke 5 curves instrumented to L3. METHODS: A multicentre registry of adolescent idiopathic scoliosispatients was queried for surgically treated Lenke 5 curves with a lowest instrumented vertebra (LIV) of L3 and minimum 2 years of follow-up. Five seasoned surgeons qualitatively rated the 2-year postoperative images as "ideal" or "less than ideal" with respect to correction and alignment. Preoperative and postoperative radiographic variables were compared between the two groups. Multivariate regression analysis was performed to determine variables most predictive of a "less than ideal" outcome. RESULTS: One hundred and thirty-nine patients met criteria. Twenty-three were considered "less than ideal" by ≥ 3 surgeons; 81 were unanimously "ideal". Preoperatively, the "less than ideal" group had significantly stiffer curves, greater apical translation, and greater LIV angulation and translation. Multivariate regression found that preoperative L3 translation (p = 0.009) was the single most important predictor of a "less than ideal" outcome: < 3.5 cm consistently resulted in an "ideal" outcome, while > 3.5 cm risked a "less than ideal" result. CONCLUSION: While multiple variables are important in achieving an "ideal" outcome in Lenke 5 curves, this study found preoperative L3 translation was the most important predictor of success with an L3 translation < 3.5 cm being a potential threshold for selecting L3 as the LIV. These slides can be retrieved under Electronic Supplementary Material.
Authors: Jingfeng Li; Steven W Hwang; Zhicai Shi; Ning Yan; Changwei Yang; Chuanfeng Wang; Xiaodong Zhu; Tiesheng Hou; Ming Li Journal: Spine (Phila Pa 1976) Date: 2011-09-15 Impact factor: 3.468
Authors: Anthony Rinella; Keith Bridwell; Yongjung Kim; Jonas Rudzki; Charles Edwards; Michael Roh; Lawrence Lenke; Annette Berra Journal: Spine (Phila Pa 1976) Date: 2004-02-01 Impact factor: 3.468