[논문]Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable?

Hyun, Seung-Jae; Lenke, Lawrence G.; Kim, Yongjung; Bridwell, Keith H.; Cerpa, Meghan; Blanke, Kathy M.

doi:10.3340/jkns.2020.0348

Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable? 원문보기

Journal of Korean Neurosurgical Society = 대한신경외과학회지, v.64 no.5, 2021년, pp.776 - 783

Hyun, Seung-Jae (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) , Lenke, Lawrence G. (Department of Orthopaedic Surgery, Spine Service, Columbia University College of Physicians and Surgeons) , Kim, Yongjung (Department of Orthopaedic Surgery, Seoul Bumin Hospital) , Bridwell, Keith H. (Department of Orthopaedic Surgery, Washington University School of Medicine) , Cerpa, Meghan (Department of Orthopaedic Surgery, Spine Service, Columbia University College of Physicians and Surgeons) , Blanke, Kathy M. (Department of Orthopaedic Surgery, Washington University School of Medicine)

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Objective : The purpose of this study was to identify risk factors for distal adding on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by posterior spinal fusion (PSF) to L3 with a minimum 2-year follow-up. Methods : AIS patients undergoing PSF to L3 by two senior surgeons from 2000-2010 were analyzed. Distal AO and DJK were deemed poor radiographic results and defined as >3 cm of deviation from L3 to the center sacral vertical line (CSVL), or >10° angle at L3-4 on the posterior anterior- or lateral X-ray at ultimate follow-up. New stable vertebra (SV) and neutral vertebra (NV) scores were defined for this study. The total stability (TS) score was the sum of the SV and NV scores. Results : Ten of 76 patients (13.1%) were included in the poor radiographic outcome group. The other 66 patients were included in the good radiographic outcome group. Lower Risser grade, more SV-3 (CSVL doesn't touch the lowest instrumented vertebra [LIV]) on standing and side bending films, lesser NV and TS score, rigid L3-4 disc, more rotation and deviation of L3 were identified risk factors for AO or DJK. Age, number of fused vertebrae, curve correction, preoperative coronal/sagittal L3-4 disc angle did not differ significantly between the two groups. Multiple logistic regression results indicated that preoperative Risser grade 0, 1 (odds ratio [OR], 1.8), SV-3 at L3 in standing and side benders (OR, 2.1 and 2.8, respectively), TS score -5, -6 at L3 (OR, 4.4), rigid disc at L3-4 (OR, 3.1), LIV rotation >15° (OR, 2.9), and LIV deviation >2 cm from CSVL (OR, 2.2) were independent predictive factors. Although there was significant improvement of the of Scoliosis Research Society-22 average scores only in the good radiographic outcome group, there was no significant difference in the scores between the groups. Conclusion : The prevalence of AO or DJK at ultimate follow-up for AIS with LIV at L3 was 13.1%. To prevent AO or DJK following fusion to L3, we recommend that the CSVL touch L3 in both standing and side bending, TS score is -4 or less, the L3/4 disc is flexible, L3 is neutral (<15°) and ≤2 cm from the midline and the patient is ≥ Risser 2.

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표/그림 (7)

그림 Fig. 1. An example of radiographic measurement for deviation of the center of the L3 from the center sacral vertical line, distal junctional discal angulation at L3-4 in the coronal or sagittal plane.
그림 Fig. 2. An example of radiographic evaluation for gravity, rotational and total stability scoring system. SV : stable vertebra, NV : neutral vertebra, TS : total stability.
표 Table 1. Definition of gravity, rotational and total stability score
표 Table 2. Clinical and radiographic factors between patients with good or poor radiographic outcomes
표 Table 3. Identified risk factors associated with poor radiographic outcomes by multiple regression analysis
표 Table 4. Summary of clinical outcomes
그림 Fig. 3. Representative cases of good (A) and poor (B) radiographic outcomes. A : A 14-year-old girl having neutral (15°) L3 not touched by the CSVL and deviated more than 2 cm from the midline demonstrates poor radiographic outcome with 13° distal junctional discal angulation at L3-4 in the coronal plane. po : postoperative.

참고문헌 (16)

1 Harrington PR Treatment of scoliosis. Correction and internal fixation by spine instrumentation J Bone Joint Surg Am 44-A 591 610 1962 14036052
2 Hasler CC Hefti F Büchler P Coronal plane segmental flexibility in thoracic adolescent idiopathic scoliosis assessed by fulcrum-bending radiographs Eur Spine J 19 732 738 2010 20186443
3 Kim CW Hyun SJ Kim KJ Surgical impact on global sagittal alignment and health-related quality of life following cervical kyphosis correction surgery: systematic review Neurospine 17 497 504 2020 33022154

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4 Kim YJ Fischer CR Lenke LG Bridwell KH Boachie-Adjei O Clement JL Optimal lowest instrumented vertebra to avoid adding‐on or distal junctional kyphosis for thoracic adolescent idiopathic scoliosis Scoliosis Research Society 46th Annual Meeting 2011 Sep 14-17 Louisville, KY Podium presentation 88
5 King HA Moe JH Bradford DS Winter RB The selection of fusion levels in thoracic idiopathic scoliosis J Bone Joint Surg Am 65 1302 1313 1983 6654943
6 Lee SH Hyun SJ Jain A Cervical sagittal alignment: literature review and future directions Neurospine 17 478 496 2020 33022153

상세보기
7 Lenke LG Betz RR Harms J Bridwell KH Clements DH Lowe TG Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis J Bone Joint Surg Am 83 1169 1181 2001 11507125
8 Lenke LG Braun JT Bridwell KH Dimar JR Dobbs M Glassman S Reliability analysis of end, neutral, stable, and lowest instrumented vertebrae selection in adolescent idiopathic scoliosis: Surgeon versus digital software determination 12th International Meeting on Advanced Spine Techniques 2005 Jul 7-9 Banff, Canada Podium presentation 46
9 Lenke LG Bridwell KH Baldus C Blanke K Schoenecker PL Ability of Cotrel-Dubousset instrumentation to preserve distal lumbar motion segments in adolescent idiopathic scoliosis J Spinal Disord 6 339 350 1993 8219548

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10 Lenke LG Newton PO Lehman RA Kelly MP Clements DH Errico TJ Radiographic results of selecting the touched vertebra as the lowest instrumented vertebra in Lenke 1A AIS curves at a minimum five-year follow up Scoliosis Research Society 49th Annual Meeting 2014 Sep 11-13 Anchorage, AK Podium presentation 5
11 Park BJ Hyun SJ Wui SH Jung JM Kim KJ Jahng TA Surgical outcomes and complications following all posterior approach for spinal deformity associated with neurofibromatosis type-1 J Korean Neurosurg Soc 63 738 746 2020 32512989

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12 Perdriolle R Vidal J Morphology of scoliosis: three-dimensional evolution Orthopedics 10 909 915 1987 3615285

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13 Qin X Sun W Xu L Liu Z Qiu Y Zhu Z Selecting the last “substantially” touching vertebra as lowest instrumented vertebra in Lenke type 1A curve: radiographic outcomes with a minimum of 2-year follow-up Spine (Phila Pa 1976) 41 E742 E750 2016 26656044
14 Suk SI Lee SM Chung ER Kim JH Kim WJ Sohn HM Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis Spine (Phila Pa 1976) 28 484 491 2003 12616162
15 Wang Y Hansen ES Høy K Wu C Bünger CE Distal adding-on phenomenon in Lenke 1A scoliosis: risk factor identification and treatment strategy comparison Spine (Phila Pa 1976) 36 1113 1122 2011 21242876
16 Wui SH Hyun SJ Kang B Kim KJ Jahng TA Kim HJ Bicortical screw purchase at upper instrumented vertebra (UIV) can cause UIV fracture after adult spinal deformity surgery: a finite element analysis study Neurospine 17 377 383 2020 31319661

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Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable? 원문보기

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Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable? 원문보기

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