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

Abstract

OBJECTIVEThe 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).METHODSTwenty-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.RESULTSPatients 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).CONCLUSIONSThe 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.

Keywords: 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; UIV translation; adolescent idiopathic scoliosis; anterior spinal fusion; main thoracic curve; spine; upper instrumented vertebra.