Hyper-Selective Posterior Fusion is Recommended When the Modified S-Line is Positive in Lenke 5C Adolescent Idiopathic Scoliosis.

Publisher: Wiley on behalf of the Chinese Orthopedic Association Country of Publication: Australia NLM ID: 101501666 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1757-7861 (Electronic) Linking ISSN: 17577853 NLM ISO Abbreviation: Orthop Surg Subsets: MEDLINE

Publication: 2013- : Richmond, Vic. Wiley on behalf of the Chinese Orthopedic Association
Original Publication: Richmond, Vic. : Tianjin : Blackwell Pub. Asia ; Tianjin Hospital, 2009-

Scoliosis*/surgery ; Scoliosis*/diagnostic imaging ; Spinal Fusion*/methods; Humans ; Adolescent ; Retrospective Studies ; Female ; Male ; Thoracic Vertebrae/surgery ; Lumbar Vertebrae/surgery ; Child

Objective: Postoperative coronal decompensation and less fusion level are dilemmas and the proper selective posterior fusion (SPF) strategy should be investigated. We proposed a parameter, modified S-line, and aimed to investigate if the modified S-line could predict postoperative coronal decompensation in patients with Lenke 5C adolescent idiopathic scoliosis (AIS).
Methods: This is a retrospective radiographic study and Lenke 5C AIS patients undergoing SPF during the period from September 2017 to June 2021 were included. The modified S-line was defined as the line linking the centers of the concave-side pedicles of the upper end vertebra (UEV) and lower end vertebra (LEV) at baseline. A modified S-line tilt to the right is established as modified S-line+ (UEV being to the right of the LEV). The patients were further categorized into two groups: the Cobb to Cobb fusion group and the Cobb-1 to Cobb fusion group. Outcomes including thoracic Cobb angle, TL/L Cobb angle, coronal balance, upper instrumented vertebra (UIV) translation, lower instrumented vertebra (LIV) translation, UIV tilt, LIV tilt, LIV disc angle, thoracic apical vertebral translation, lumbar apical vertebral translation (L-AVT), L-T AVT ratio, L-T Cobb were measured at baseline, immediately after surgery, and the last follow-up. Radiographic parameters and the incidence of both proximal and distal decompensation between the two groups were compared by chi-square test.
Results: Among 92 patients, 48 were modified S-line+ and 44 were modified S-line-. Modified S-line+ status was identified as a risk factor for postoperative proximal decompensation (p = 0.005) during follow-up. In Cobb to Cobb group, a higher occurrence of proximal decompensation in individuals with modified S-line+ status (p = 0.001) was confirmed. Also, in the Cobb to Cobb group with baseline modified S-line+ status, patients presenting decompensation showed a significantly larger baseline of the UIV tilt and postoperative disc angle below the lower instrumented vertebra. However, In Cobb-1 group, the incidence of decompensation after surgery showed no association with baseline modified S-line tilt status (p = 0.815 and 0.540, respectively).
Conclusion: The modified S-line could serve as an important parameter in surgical decision-making for Lenke 5C AIS patients. Cobb to Cobb SPF is not recommended with a modified S-line+ status, and the Cobb-1 to Cobb fusion may serve as a potential alternative.
(© 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

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：M2022003 Medical research project of Jiangsu Health Commission

Keywords: Adolescent Idiopathic Scoliosis; Decompensation; Lower Instrumented Vertebra; Spinal Deformity; Upper End Vertebra

Date Created: 20240505 Date Completed: 20240602 Latest Revision: 20240604

20240604

PMC11144515

10.1111/os.14073

38706032