Related Experiment Video
Updated: Sep 8, 2025
04:19
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
573
Principles of Level Selection for Instrumentation in Adult Thoracolumbar Spinal Deformity Surgery: Guidelines for
Zeeshan M Sardar1, Josephine R Coury1, Katherine Dong2
1Department of Orthopedic Surgery, Columbia University and NewYork-Presbyterian Och Spine Hospital, New York, NY.
The Journal of Bone and Joint Surgery. American Volume
|September 5, 2025
Summary
This study guides spinal fusion level selection for adult scoliosis and hyperkyphosis. It details instrumented vertebra choices and criteria for considering pelvic fixation in complex cases.
Area of Science:
- Orthopedic Surgery
- Spinal Deformity Correction
- Adult Spinal Deformities
Background:
- Accurate level selection is crucial for successful surgical correction of adult spinal deformities.
- Existing classification systems provide a framework, but specific guidance for instrumented levels in various deformity types is essential.
- Understanding criteria for pelvic fixation can optimize outcomes in complex cases.
Purpose of the Study:
- To provide clear guidelines for selecting upper and lower instrumented vertebrae in adult idiopathic scoliosis and hyperkyphotic deformities.
- To outline indications for utilizing pelvic fixation in complex spinal reconstructions.
- To enhance surgical planning and improve patient outcomes for adult spinal deformities.
Main Methods:
- Application of the Lenke classification principles for scoliotic deformities.
- Identification of appropriate upper and lower instrumented vertebrae for hyperkyphotic deformities.
- Analysis of criteria necessitating pelvic fixation, including fusion length, osteotomy complexity, and patient-specific factors like osteoporosis or L5-S1 degeneration.
Main Results:
- The Lenke classification effectively guides level selection for primarily scoliotic adult idiopathic scoliosis.
- For hyperkyphosis, the upper end vertebra is recommended as the upper instrumented vertebra, with the sagittal stable vertebra or first lordotic vertebra as options for the lower instrumented vertebra when sacral fusion is avoided.
- Pelvic fixation is indicated for planned fusions to the sacrum of 4 or more levels, L3-L5 3-column osteotomies, osteoporosis, or significant L5-S1 degeneration/stenosis.
Conclusions:
- Modular Lenke classification principles are applicable to adult idiopathic scoliosis level selection.
- Specific vertebral levels are recommended for instrumentation in hyperkyphotic deformities.
- Pelvic fixation is a valuable consideration in complex adult spinal deformity cases with specific indications.
