DOI QR코드

DOI QR Code

Selection of Fusion Level for Adolescent Idiopathic Scoliosis Surgery : Selective Fusion versus Postoperative Decompensation

  • Kim, Do-Hyoung (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hyun, Seung-Jae (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Ki-Jeong (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2020.09.02
  • Accepted : 2020.10.09
  • Published : 2021.07.01

Abstract

Adolescent idiopathic scoliosis (AIS), which is associated with an extensive range of clinical and radiological presentations, is the one of the most challenging spinal disorders. The goals of surgery are to correct the deformity in 3 dimensions and to preserve motion segments while avoiding complications. Despite the ongoing evolution of classification systems and algorithms for the surgical treatment of AIS, there has been considerable debate regarding the selection of an appropriate fusion level in AIS. In addition, there is no consensus regarding the exact description, relationship, and risk factors of coronal decompensation following selective fusion. In this review, we summarize the current concepts of selection of the fusion level for AIS and review the available information about postoperative coronal decompensation.

Keywords

References

  1. Akazawa T, Kotani T, Sakuma T, Minami S, Orita S, Fujimoto K, et al. : Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery. Spine Surg Relat Res 1 : 72-77, 2017 https://doi.org/10.22603/ssrr.1.2016-0017
  2. Bennett JT, Hoashi JS, Ames RJ, Kimball JS, Pahys JM, Samdani AF : The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves. J Neurosurg Spine 19 : 658-663, 2013 https://doi.org/10.3171/2013.8.SPINE12816
  3. Chang DG, Yang JH, Suk SI, Suh SW, Kim YH, Cho W, et al. : Importance of distal fusion level in major thoracolumbar and lumbar adolescent idiopathic scoliosis treated by rod derotation and direct vertebral rotation following pedicle screw instrumentation. Spine (Phila Pa 1976) 42 : E890-E898, 2017 https://doi.org/10.1097/BRS.0000000000001998
  4. Chang KW, Leng X, Zhao W, Chen YY, Chen TC, Chang KI : Broader curve criteria for selective thoracic fusion. Spine (Phila Pa 1976) 36 : 1658-1664, 2011 https://doi.org/10.1097/BRS.0b013e318215fa73
  5. Cil A, Pekmezci M, Yazici M, Alanay A, Acaroglu RE, Deviren V, et al. : The validity of Lenke criteria for defining structural proximal thoracic curves in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 30 : 2550-2555, 2005 https://doi.org/10.1097/01.brs.0000186579.74398.15
  6. Crawford CH 3rd, Lenke LG, Sucato DJ, Richards BS 3rd, Emans JB, Vitale MG, et al. : Selective thoracic fusion in Lenke 1C curves: prevalence and criteria. Spine (Phila Pa 1976) 38 : 1380-1385, 2013 https://doi.org/10.1097/BRS.0b013e3182987360
  7. Daher MT, Melo NC, Nascimento VN, Felisbino Jr P, AraUJo BCR, Daher S, et al. : What is the best distal level of arthrodesis in lumbar fusion in patients with adolescent idiopathic scoliosis: L3 or L4? Coluna/Columna 18 : 200-204, 2019 https://doi.org/10.1590/s1808-185120191803197205
  8. Ding R, Liang J, Qiu G, Shen J, Li Z : Evaluation of quality of life in adolescent idiopathic scoliosis with different distal fusion level: a comparison of L3 versus L4. J Spinal Disord Tech 27 : E155-E161, 2014 https://doi.org/10.1097/BSD.0000000000000073
  9. Elfiky TA, Samartzis D, Cheung WY, Wong YW, Luk KD, Cheung KM : The proximal thoracic curve in adolescent idiopathic scoliosis: surgical strategy and management outcomes. Global Spine J 1 : 27-36, 2011 https://doi.org/10.1055/s-0031-1296054
  10. Fischer CR, Kim Y : Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy. Eur Spine J 20 : 1048-1057, 2011 https://doi.org/10.1007/s00586-011-1730-9
  11. Fischer CR, Lenke LG, Bridwell KH, Boachie-Adjei O, Gupta M, Kim YJ : Optimal lowest instrumented vertebra for thoracic adolescent idiopathic scoliosis. Spine Deform 6 : 250-256, 2018 https://doi.org/10.1016/j.jspd.2017.10.002
  12. Fruergaard S, Ohrt-Nissen S, Dahl B, Kaltoft N, Gehrchen M : Neural axis abnormalities in patients with adolescent idiopathic scoliosis: is routine magnetic resonance imaging indicated irrespective of curve severity? Neurospine 16 : 339-346, 2019 https://doi.org/10.14245/ns.1836154.077
  13. Gomez JA, Matsumoto H, Colacchio ND, Roye DP Jr, Sucato DJ, Richards BS, et al. : Risk factors for coronal decompensation after posterior spinal instrumentation and fusion in adolescent idiopathic scoliosis. Spine Deform 2 : 380-385, 2014 https://doi.org/10.1016/j.jspd.2014.05.001
  14. Goshi K, Boachie-Adjei O, Moore C, Nishiyama M : Thoracic scoliosis fusion in adolescent and adult idiopathic scoliosis using posterior translational corrective techniques (Isola): is maximum correction of the thoracic curve detrimental to the unfused lumbar curve? Spine J 4 : 192-201, 2004 https://doi.org/10.1016/j.spinee.2003.08.025
  15. Harrington PR : Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am 44-A : 591-610, 1962 https://doi.org/10.2106/00004623-196244040-00001
  16. Hwang CJ, Lee CS, Kim H, Lee DH, Cho JH : Spontaneous correction of coronal imbalance after selective thoracolumbar-lumbar fusion in patients with Lenke-5C adolescent idiopathic scoliosis. Spine J 18 : 1822-1828, 2018 https://doi.org/10.1016/j.spinee.2018.03.013
  17. Hyun SJ, Lenke LG, Cerpa M, Kim YJ, Bridwell KH, Koester LA, et al. : Adolescent idiopathic scoliosis treated by posterior spinal segmental instrumented fusion: when is fusion to L3 stable? 22th International Meeting on Advanced Spine Techniques, 2015; Kuala Lumpur, Malaysia. Paper#41
  18. Hyun SJ, Lenke LG, Kim YJ, Bridwell KH, Koester LA, Blanke K : The prevalence of adding-on or distal junctional kyphosis in adolescent idiopathic scoliosis treated by anterior spinal fusion to L3 was significantly higher than by posterior spinal fusion to L3. SRS 53th Annual Meeting & Course, 2018; Bologna, Italy. #108
  19. Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Presedo A, Souchet P, et al. : How to determine the upper level of instrumentation in Lenke types 1 and 2 adolescent idiopathic scoliosis: a prospective study of 132 patients. J Pediatr Orthop 28 : 733-739, 2008 https://doi.org/10.1097/BPO.0b013e318185a36b
  20. Ilharreborde B, Ferrero E, Angelliaume A, Lefevre Y, Accadbled F, Simon AL, et al. : Selective versus hyperselective posterior fusions in Lenke 5 adolescent idiopathic scoliosis: comparison of radiological and clinical outcomes. Eur Spine J 26 : 1739-1747, 2017 https://doi.org/10.1007/s00586-017-5070-2
  21. Ishikawa M, Cao K, Pang L, Fujita N, Yagi M, Hosogane N, et al. : Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study). Scoliosis Spinal Disord 12 : 16, 2017 https://doi.org/10.1186/s13013-017-0123-1
  22. Joshi RS, Haddad AF, Lau D, Ames CP : Artificial intelligence for adult spinal deformity. Neurospine 16 : 686-694, 2019 https://doi.org/10.14245/ns.1938414.207
  23. Karami M, Maleki A, Mazda K : Assessment of coronal radiographic parameters of the spine in the treatment of adolescent idiopathic scoliosis. Arch Bone Jt Surg 4 : 376-380, 2016
  24. Kim SS, Lim DJ, Kim JH, Kim JW, Um KS, Ahn SH, et al. : Determination of the distal fusion level in the management of thoracolumbar and lumbar adolescent idiopathic scoliosis using pedicle screw instrumentation. Asian Spine J 8 : 804-812, 2014 https://doi.org/10.4184/asj.2014.8.6.804
  25. Kim YJ, Bridwell KH, Lenke LG, Kim J, Cho SK : Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine (Phila Pa 1976) 30 : 2045-2050, 2005 https://doi.org/10.1097/01.brs.0000179084.45839.ad
  26. Kim YJ, Hyun SJ, Cheh G, Cho SK, Rhim SC : Decision making algorithm for adult spinal deformity surgery. J Korean Neurosurg Soc 59 : 327-333, 2016 https://doi.org/10.3340/jkns.2016.59.4.327
  27. 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 https://doi.org/10.2106/00004623-198365090-00012
  28. Kuklo TR, Lenke LG, Won DS, Graham EJ, Sweet FA, Betz RR, et al. : Spontaneous proximal thoracic curve correction after isolated fusion of the main thoracic curve in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 26 : 1966-1975, 2001 https://doi.org/10.1097/00007632-200109150-00006
  29. Lee CK, Denis F, Winter RB, Lonstein JE : Analysis of the upper thoracic curve in surgically treated idiopathic scoliosis. A new concept of the double thoracic curve pattern. Spine (Phila Pa 1976) 18 : 1599-1608, 1993 https://doi.org/10.1097/00007632-199309000-00006
  30. Lee CS, Ha JK, Hwang CJ, Lee DH, Kim TH, Cho JH : Is it enough to stop distal fusion at L3 in adolescent idiopathic scoliosis with major thoracolumbar/lumbar curves? Eur Spine J 25 : 3256-3264, 2016 https://doi.org/10.1007/s00586-015-4373-4
  31. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, et al. : Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83 : 1169-1181, 2001 https://doi.org/10.2106/00004623-200108000-00006
  32. Lenke LG, Bridwell KH, O'Brien MF, Baldus C, Blanke K : Recognition and treatment of the proximal thoracic curve in adolescent idiopathic scoliosis treated with Cotrel-Dubousset instrumentation. Spine (Phila Pa 1976) 19 : 1589-1597, 1994 https://doi.org/10.1097/00007632-199407001-00007
  33. Lenke LG, Edwards CC 2nd, Bridwell KH : The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976) 28 : S199-S207, 2003 https://doi.org/10.1097/01.BRS.0000092216.16155.33
  34. Liu Z, Guo J, Zhu Z, Qian B, Sun X, Xu L, et al. : Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion. Eur Spine J 22 : 2392-2398, 2013 https://doi.org/10.1007/s00586-013-2808-3
  35. Matsumoto M, Watanabe K, Hosogane N, Kawakami N, Tsuji T, Uno K, et al. : Postoperative distal adding-on and related factors in Lenke type 1A curve. Spine (Phila Pa 1976) 38 : 737-744, 2013 https://doi.org/10.1097/BRS.0b013e318279b666
  36. Moe JH : A critical analysis of methods of fusion for scoliosis; an evaluation in two hundred and sixty-six patients. J Bone Joint Surg Am 40-A : 529-554 passim, 1958
  37. Nash CL, Moe JH : A study of vertebral rotation. J Bone Joint Surg Am 51 : 223-229, 1969 https://doi.org/10.2106/00004623-196951020-00002
  38. Newton PO, Faro FD, Lenke LG, Betz RR, Clements DH, Lowe TG, et al. : Factors involved in the decision to perform a selective versus nonselective fusion of Lenke 1B and 1C (King-Moe II) curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 28 : S217-S223, 2003 https://doi.org/10.1097/01.BRS.0000092461.11181.CD
  39. Okada E, Watanabe K, Pang L, Ogura Y, Takahashi Y, Hosogane N, et al. : Posterior correction and fusion surgery using pedicle-screw constructs for Lenke type 5C adolescent idiopathic scoliosis: a preliminary report. Spine (Phila Pa 1976) 40 : 25-30, 2015 https://doi.org/10.1097/BRS.0000000000000652
  40. Parisini P, Di Silvestre M, Lolli F, Bakaloudis G : Selective thoracic surgery in the Lenke type 1A: king III and king IV type curves. Eur Spine J 18 Suppl 1 : 82-88, 2009 https://doi.org/10.1007/s00586-009-0990-0
  41. Pham MH, Cerpa M, Makhni MC, Sielatycki JA, Lenke LG : Neurologic deficit during halo-gravity traction in the treatment of severe thoracic kyphoscoliotic spinal deformity. Neurospine 17 : 461-465, 2020 https://doi.org/10.14245/ns.1938212.106
  42. Qin X, He Z, Yin R, Qiu Y, Zhu Z : Selecting the last substantially touching vertebra as lowest instrumented vertebra in Lenke type 2A-R and 2A-L curves. Spine (Phila Pa 1976) 45 : 309-318, 2020 https://doi.org/10.1097/BRS.0000000000003254
  43. Ries Z, Harpole B, Graves C, Gnanapragasam G, Larson N, Weintstein S, et al. : Selective thoracic fusion of Lenke I and II curves affects sagittal profiles but not sagittal or spinopelvic alignment: a case-control study. Spine (Phila Pa 1976) 40 : 926-934, 2015 https://doi.org/10.1097/BRS.0000000000000861
  44. Sanders AE, Baumann R, Brown H, Johnston CE 2nd, Lenke LG, Sink E : Selective anterior fusion of thoracolumbar/lumbar curves in adolescents: when can the associated thoracic curve be left unfused? Spine (Phila Pa 1976) 28 : 706-713; discussion 714, 2003 https://doi.org/10.1097/01.BRS.0000051925.88443.85
  45. Sarlak AY, Atmaca H, Kim WJ, Musaoglu R, Tosun B : Radiographic features of the Lenke 1A curves to help to determine the optimum distal fusion level selection. Spine (Phila Pa 1976) 36 : 1592-1599, 2011 https://doi.org/10.1097/BRS.0b013e3181f54f7f
  46. Shen M, Li N, Luo M, Xu G, Wang W, Wang L : Comparison of SV and LSTV as the lowest instrumented vertebra in Lenke 1A adolescent idiopathic scoliosis: SV decreasing the distal adding-on phenomenon. Int J Clin Exp Med 11 : 9520-9527, 2018
  47. Shufflebarger HL, Geck MJ, Clark CE : The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976) 29 : 269-276; discussion 276, 2004 https://doi.org/10.1097/01.BRS.0000109881.63411.48
  48. Sudo H, Kaneda K, Shono Y, Iwasaki N : Selection of the upper vertebra to be instrumented in the treatment of thoracolumbar and lumbar adolescent idiopathic scoliosis by anterior correction and fusion surgery using dual-rod instrumentation: a minimum 12-year follow-up study. Spine J 16 : 281-287, 2016 https://doi.org/10.1016/j.spinee.2015.08.021
  49. Suk SI, Kim WJ, Lee CS, Lee SM, Kim JH, Chung ER, et al. : Indications of proximal thoracic curve fusion in thoracic adolescent idiopathic scoliosis: recognition and treatment of double thoracic curve pattern in adolescent idiopathic scoliosis treated with segmental instrumentation. Spine (Phila Pa 1976) 25 : 2342-2349, 2000 https://doi.org/10.1097/00007632-200009150-00012
  50. 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 https://doi.org/10.1097/01.BRS.0000048653.75549.40
  51. Sun Z, Qiu G, Zhao Y, Wang Y, Zhang J, Shen J : Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra+1? Eur Spine J 23 : 1251-1257, 2014 https://doi.org/10.1007/s00586-014-3276-0
  52. Takahashi J, Newton PO, Ugrinow VL, Bastrom TP : Selective thoracic fusion in adolescent idiopathic scoliosis: factors influencing the selection of the optimal lowest instrumented vertebra. Spine (Phila Pa 1976) 36 : 1131-1141, 2011 https://doi.org/10.1097/BRS.0b013e3182053d19
  53. Thompson JP, Transfeldt EE, Bradford DS, Ogilvie JW, Boachie-Adjei O : Decompensation after Cotrel-Dubousset instrumentation of idiopathic scoliosis. Spine (Phila Pa 1976) 15 : 927-931, 1990 https://doi.org/10.1097/00007632-199009000-00017
  54. Trobisch PD, Ducoffe AR, Lonner BS, Errico TJ : Choosing fusion levels in adolescent idiopathic scoliosis. J Am Acad Orthop Surg 21 : 519-528, 2013 https://doi.org/10.5435/JAAOS-21-09-519
  55. Wang T, Xu JG, Zeng BF : Selective fusion in adolescent idiopathic scoliosis. Chin Med J (Engl) 121 : 1456-1461, 2008 https://doi.org/10.1097/00029330-200808010-00022
  56. Wang Y, Hansen ES, Hoy K, Wu C, Bunger CE : Distal adding-on phenomenon in Lenke 1A scoliosis: risk factor identification and treatment strategy comparison. Spine (Phila Pa 1976) 36 : 1113-1122, 2011 https://doi.org/10.1097/BRS.0b013e3181f51e95
  57. Ward WT, Friel NA, Kenkre TS, Brooks MM, Londino JA, Roach JW : SRS-22r scores in nonoperated adolescent idiopathic scoliosis patients with curves greater than forty degrees. Spine (Phila Pa 1976) 42 : 1233-1240, 2017 https://doi.org/10.1097/BRS.0000000000002004
  58. Watanabe K, Aoki Y, Matsumoto M : An application of artificial intelligence to diagnostic imaging of spine disease: estimating spinal alignment from moire images. Neurospine 16 : 697-702, 2019 https://doi.org/10.14245/ns.1938426.213
  59. Winter RB, Lonstein JE, Denis F : How much correction is enough? Spine 32: 2641-2643, 2007 https://doi.org/10.1097/BRS.0b013e31815a5207
  60. 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 https://doi.org/10.14245/ns.1938100.050
  61. Zhao Y, Wang Z, Zhu X, Wang C, He S, Li M : Prediction of postoperative trunk imbalance after posterior spinal fusion with pedicle screw fixation for adolescent idiopathic scoliosis. J Pediatr Orthop B 20 : 199-208, 2011 https://doi.org/10.1097/BPB.0b013e328344e727

Cited by

  1. The Incidence of Adding-On or Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Treated by Anterior Spinal Fusion to L3 Was Significantly Higher Than by Posterior Spinal Fusion to L3 vol.18, pp.3, 2021, https://doi.org/10.14245/ns.2142182.091
  2. Regional Anesthesia for Lumbar Spine Surgery: Can It Be a Standard in the Future? vol.18, pp.4, 2021, https://doi.org/10.14245/ns.2142584.292