Postoperative translation of the upper instrumented vertebra in thoracic adolescent idiopathic scoliosis

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OBJECTIVE

The aim of this retrospective study was to analyze the influence of upper instrumented vertebra (UIV) translation from the C7 plumb line (C7PL) on the long-term postoperative results of patients with main thoracic (MT) adolescent idiopathic scoliosis (AIS).

METHODS

Twenty-five patients had been treated surgically for AIS with a Lenke type 1 curve and had been followed up for a mean period of 18.2 years. Radiographic parameters, pulmonary function measurements, and clinical outcomes were compared between the patients (n = 15) with UIV translation < 20 mm and those (n = 10) with UIV translation ≥ 20 mm at the final follow-up. Correlations between UIV translation and radiographic or pulmonary function parameters were analyzed.

RESULTS

Patients with ≥ 20 mm UIV translation at the final follow-up had a significantly larger preoperative UIV translation than that in the patients with < 20 mm UIV translation at follow-up. The former group also had a significantly lower correction rate of the MT curve, higher chest cage ratio, and lower radiographic shoulder height (p = 0.01, 0.005, and 0.025, respectively) at the final follow-up. The Scoliosis Research Society (SRS)–30 Questionnaire scores were equivalent between the two groups. Correlation analysis showed that the following parameters were significantly associated with UIV translation: MT curve correction rate (r = -0.481, p = 0.015), chest cage ratio (r = 0.673, p < 0.001), and percent-predicted forced expiratory volume in 1 second (r = -0.455, p = 0.033).

CONCLUSIONS

The UIV translation should be considered an important factor that influences postoperative results. In MT AIS patients whose preoperative upper end vertebra (UEV) is distant from the C7PL, the UIV should be selected above the UEV to prevent large UIV translation at the postoperative follow-up.

ABBREVIATIONS AIS = adolescent idiopathic scoliosis; ASF = anterior spinal fusion; AVT = apical vertebral translation; C7PL = C7 plumb line; CSVL = center sacral vertical line; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; LEV = lower end vertebra; LIV = lower instrumented vertebra; MT = main thoracic; PSF = posterior spinal fusion; PT = proximal thoracic; RSH = radiographic shoulder height; SRS = Scoliosis Research Society; UEV = upper end vertebra; UIV = upper instrumented vertebra.

Article Information

Correspondence Hideki Sudo: Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan. hidekisudo@yahoo.co.jp.

INCLUDE WHEN CITING Published online September 7, 2018; DOI: 10.3171/2018.6.PEDS18256.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    Radiographs obtained in a 20-year-old woman with UIV translation ≥ 20 mm. The UIV translation was measured as the distance between the geometrical center of the UIV and the C7PL. The UIV translation was 51 mm before surgery (A), was corrected to 27 mm after surgery (B), and was 45 mm at the final follow-up (C).

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