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. 2021 Jul;30(7):1935-1942.
doi: 10.1007/s00586-021-06781-9. Epub 2021 Mar 4.

Optimizing the fusion level for lenke 5C adolescent idiopathic scoliosis: is the S-line a validated and reproducible tool to predict coronal decompensation?

Tianyuan Zhang  1 , Shibin Shu  1 , Wenting Jing  1 , Qi Gu  2 , Zezhang Zhu  1 , Zhen Liu  1 , Yong Qiu  1 , Xu Sun  1 , Bin Wang  1 , Hongda Bao  3
Affiliations

Optimizing the fusion level for lenke 5C adolescent idiopathic scoliosis: is the S-line a validated and reproducible tool to predict coronal decompensation?

Tianyuan Zhang et al. Eur Spine J. 2021 Jul.

Abstract

Purpose: To validate the predictability of S-line in Lenke 5C patients.

Methods: Lenke 5C patients with a minimum 2-year follow-up and with the lowest instrumented vertebra (LIV) at lower end vertebra were included. The S-line was defined as a line connecting the centers of concave-side pedicles of upper instrumented vertebra (UIV) and LIV on baseline films. The S-line tilt to right was defined as positive S-line status (S-line +) and tilt to left as S-line - status. Statistical analysis was performed between different subgroups.

Results: Among the 92 patients, 69 patients had a left lumbar curve and 23 patients had a right lumbar curve. For left curves, the S-line + status had a significantly higher incidence of both proximal and distal decompensation. However, for right curves, the S-line - status was the risk factor. Thus, we modified the definition of S-line: The value of S-line tilt for right curves was opposite to that for left curves. Patients with modified S-line + showed a significantly higher incidence of both proximal and distal decompensation in Lenke 5C patients with both left and right curves (p < 0.001 and p = 0.010). In UEV group, patients with modified S-line + showed significantly higher incidence of proximal decompensation (P = 0.001). However, in UEV-1 group, the incidence of proximal decompensation was not statistically affected by modified S-line + (P = 0.281).

Conclusion: Modified S-line + is a validated risk factor that predisposed to post-operative coronal decompensation in Lenke 5C AIS patients. Selecting UIV at one level caudal to UEV could be a possible solution if the modified S-line was positive.

Keywords: Adolescent idiopathic scoliosis; Coronal decompensation; Lower instrumented vertebra; Upper end vertebra; Upper instrumented vertebra.

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