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Postoperative distal adding-on and related factors in Lenke type 1A curve

Morio Matsumoto1, Kota Watanabe, Naobumi Hosogane

  • 1*Department of Orthopaedic Surgery, Keio University, Tokyo, Japan †Department of Orthopaedic Surgery, Meijo Hospital, Nagoya Japan ‡Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Hyogo, Japan §Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan ¶Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Fukuoka, Japan; and ‖Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan.

Spine
|October 30, 2012
PubMed

Insights

Postoperative adding-on in Lenke type 1A curves is associated with residual main thoracic curve apical translation and the lowest instrumented vertebra (LIV) position. Surgeons should aim for maximal apical translation reduction and place the LIV at or below the last touching vertebra (LTV) to prevent this complication.

Area of Science:

  • Spine surgery
  • Orthopedic surgery
  • Scoliosis correction

Background:

  • Lenke type 1A scoliosis presents unique challenges in surgical correction.
  • Factors influencing postoperative adding-on in this curve type require further elucidation in large cohorts.

Purpose of the Study:

  • To investigate the incidence and contributing factors of postoperative adding-on in Lenke type 1A curves.
  • To identify surgical parameters that can mitigate this complication.

Main Methods:

  • A retrospective multicenter study of 112 patients with Lenke type 1A curves undergoing selective posterior thoracic fusion.
  • Analysis of radiographic parameters including apical translation, curve correction, and vertebral levels (LIV, LTV) pre- and post-operatively.
  • Logistic regression to identify factors associated with distal adding-on.

Main Results:

  • Distal adding-on occurred in 18.8% of patients.
  • Significant factors associated with adding-on included postoperative apical translation of the main thoracic curve and the difference between the lowest instrumented vertebra (LIV) and the last touching vertebra (LTV).
  • Specifically, apical translation >25 mm (OR 10.7) and LIV-LTV <0 (OR 6.7) were strongly predictive of adding-on.

Conclusions:

  • Residual apical translation of the main thoracic curve and a cranial placement of the LIV relative to the LTV are significant predictors of postoperative adding-on.
  • Optimizing surgical technique to maximize apical translation correction and ensure adequate distal fusion to the LTV is crucial for preventing adding-on.
Abstract

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