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Prediction of long-term postoperative results of disc wedge and vertebral tilt with intraoperative prone radiograph in posterior correction of thoracolumbar/lumbar curve in adolescent idiopathic scoliosis: a minimum 5-year follow-up

 Choon Sung Lee  ;  Kun-Bo Park  ;  Chang Ju Hwang  ;  Jae Hwan Cho  ;  Dong-Ho Lee  ;  Sehan Park 
 SPINE JOURNAL, Vol.22(3) : 463-471, 2022-03 
Journal Title
Issue Date
Adolescent ; Follow-Up Studies ; Humans ; Lumbar Vertebrae / diagnostic imaging ; Lumbar Vertebrae / surgery ; Radiography ; Retrospective Studies ; Scoliosis* / diagnostic imaging ; Scoliosis* / surgery ; Spinal Fusion* / methods ; Thoracic Vertebrae / diagnostic imaging ; Thoracic Vertebrae / surgery ; Treatment Outcome
Disc wedge angle ; Intraoperative radiograph ; Lowermost instrumented vertebra ; Thoracolumbar scoliosis ; Vertebral body tilt
Background context: Preservation of the more mobile lumbar segments is important during thoracolumbar/lumbar scoliosis surgery; however, the remaining disc wedge angle (DWA) below lowermost instrumented vertebra (LIV) and vertebral body tilt below LIV (LIV+1 tilt) can cause curve progression.

Purpose: This study aimed to evaluate the efficacy of intraoperative radiograph to predict the postoperative DWA below LIV and LIV+1 tilt on standing radiographs in patients with LIV of L3 or L4.

Study design/setting: Retrospective cohort study PATIENT SAMPLE: A total of 235 patients with idiopathic scoliosis who underwent posterior correction and fusion for the structural thoracolumbar curve and were followed up for >5 years were reviewed.

Outcome measures: DWA below LIV, LIV+1 tilt, Cobb angle, trunk shift, apical vertebra translation, and pelvic parameters were measured.

Methods: Correlation between intraoperative and postoperative measurements of DWA below LIV and LIV+1 tilt were assessed. Additional analysis was performed to identify risk factors and prognosis of LIV+1 tilt ≥10° and DWA below LIV of ≥4° RESULTS: LIV+1 tilt measured on intraoperative radiograph was significantly correlated with the postoperative 5-day and postoperative 5-year evaluation in both groups. However, the intraoperative DWA below LIV was only correlated with the postoperative 5-year value in the L3 group (p=.018). At the 5-year follow-up, patients with LIV+1 tilt ≥10° on intraoperative radiography showed significantly greater LIV+1 tilt (p<.001), apical vertebral translation (p<.001), thoracic curve (p=.008), and thoracolumbar curve (p<.001) than patients with LIV+1 tilt <10°. Intraoperative DWA below LIV of ≥4° was only associated with higher DWA below LIV at the 5-year follow-up.

Conclusions: Intraoperative measurement of LIV+1 tilt was correlated with long-term postoperative outcomes, and intraoperative LIV+1 tilt ≥10° was associated with a less favorable radiographic outcome. Intraoperative DWA below LIV demonstrated less correlation with postoperative values and was not a prognostic factor for other radiographic parameters.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Kun Bo(박건보) ORCID logo https://orcid.org/0000-0002-8839-4870
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