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Postoperative forward flexion loss in Adolescent Idiopathic Scoliosis: How it relates to the lowest instrumented
Sebastiaan Schelfaut1, Thijs Ackermans2, Fred Ruythooren1
1Division of Orthopaedics, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
Background:
Spinal fusion is a common treatment for severe, progressive Adolescent Idiopathic Scoliosis (AIS). Maximum safe preservation of motion segments, particularly in the lumbar spine, is a widely accepted surgical goal. However, the specific relationship between reduced spinal motion and fusion length/lowest instrumented vertebra (LIV) and its effect on functional outcomes remains largely unexplored.
Research Question:
Is there a difference in trunk mobility and functional outcomes between thoracolumbar (TL) and thoracic-only (T) fusion groups? Additionally, is a greater loss of seated forward flexion trunk mobility after fusion in AIS patients associated with worse functional outcomes and a greater LIV score?
Methods:
This study includes 37 AIS patients (11-29 y), with a mean follow-up of 1-year. Data collected preoperatively, at 3-months, and 1-year included structural, motion, and functional assessments (PROMs and activity tracking). These were compared between groups experiencing greater reduction in trunk mobility (high RoM loss) and those with lesser reduction of trunk mobility (low RoM loss), as well as between thoracolumbar (TL) and thoracic (T) fusion groups.
Results:
At 3 months follow-up, the high RoM loss group demonstrated significantly lower SRS function scores (p = 0.028), and significantly higher LIV score (p = 0.032) compared to the low RoM loss group. No significant difference in fusion length between low and high RoM loss groups was found (p = 0.630). Notably, the TL fusion group exhibited greater percentage changes in trunk mobility at 3 months compared to the T fusion group, although these differences were not statistically significant. Moreover, SRS-function score and SC showed no significant differences between T and TL fusion groups.
Significance:
These results suggest that a greater reduction in trunk mobility could lead to poorer functional outcomes at 3 months follow-up and may be associated with a more distally located LIV following fusion surgery in AIS patients.
