Which Criterion Is More Reliable for Selecting the Distal Fusion Level in Cases of Adolescent Idiopathic Scoliosis with Structural Thoracolumbar/Lumbar Curves: Static or Dynamic? (구조적 흉요부/요부 만곡 청소년기 특발성 측만증에서 원위부 유합 범위를 결정하는데 있어서 동적 혹은 정적 기준의 신뢰도 비교)

Jae Hwan Cho (조재환); Chang Ju Hwang (황창주); Jae Woo Park (박재우); Dong-Ho Lee (이동호); Choon Sung Lee (이춘성)

Which Criterion Is More Reliable for Selecting the Distal Fusion Level in Cases of Adolescent Idiopathic Scoliosis with Structural Thoracolumbar/Lumbar Curves: Static or Dynamic?

Journal of Korean Society of Spine Surgery
Abbr : J Kor Spine Sur
2019, 26(4), pp.132-140
Publisher : Korean Society Of Spine Surgery
Research Area : Medicine and Pharmacy > Orthopedic Surgery
Published : December 31, 2019

Jae Hwan Cho ¹, Chang Ju Hwang ², Jae Woo Park ², Dong-Ho Lee ², Choon Sung Lee ³

¹울산대학교
²울산대학교 의과대학 정형외과학교실
³울산대학교의과대학 서울아산병원 정형외과

Accredited

ABSTRACT

Study Design: Retrospective comparative study. Objectives: To compare the reliability of 2 criteria to predict the radiological outcomes of corrective surgery in cases of adolescent idiopathic scoliosis (AIS) with structural thoracolumbar/lumbar (TL/L) curves. Summary of Literature Review: Distal fusion level selection in AIS with structural TL/L curves is debatable. Materials and Methods: This study included 131 AIS patients with structural TL/L curves who underwent corrective surgery in which distal fusion was stopped at L3. Whole-spine standing radiographs and bending radiographs were obtained preoperatively. The patients were divided into 2 groups according to their findings on bending radiographs (dynamic criterion) and by the last touching vertebra and the lower end vertebra (static criterion). Radiological outcomes were assessed by reviewing postoperative radiographs. Reliability tests were conducted to compare the predictability of radiological outcomes using these 2 methods. In addition, radiological parameters were compared between both criteria. Results: Among 131 patients, 25 showed radiologically poor outcomes (19.1%). The sensitivity of the dynamic and static criteria was 0.69 and 0.50, respectively. The specificity of each criterion was 0.49 and 0.64, respectively. Overall, the dynamic criterion showed superior reliability (p=0.03). However, no significant difference in radiological parameters could be found in a comparison of both criteria. Conclusions: Although the dynamic criterion was more sensitive for predicting poor radiological outcomes when stopping fusion at L3 in patients with structural TL/L curves, its specificity was lower than that of the static criterion. Thus, both dynamic and static criteria should be considered when selecting the distal fusion level in cases of AIS with structural TL/L curves. Key words: Adolescent idiopathic scoliosis, Double major curve, Distal fusion level, Lower instrumented vertebra

KEYWORDS

Adolescent idiopathic scoliosis, Double major curve, Distal fusion level, Lower instrumented vertebra

Citation status

* References for papers published after 2023 are currently being built.

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