Abstract

Objective To establish the criteria of the lowest instrumented vertebrae(LIV) for adoles-cent idiopathic scoliosis (AIS). Methods A consecutive of 33 cases with AIS receiving posterior correction and fusion following the LIV criteria with over 2 year follow-up (range, 24-36 months)were reviewed.There were 4 males and 29 females. The average age at surgery was 14.2 years. All cases were fused to the touched vertebra, which was defined as the most cephalad vertebrae touched by central sacrum vertical line with Grade Ⅰ or less rotation on the standing anterio-posterior radiograph, and two-thirds of its vertebral body can fall within the Harrington stable zone, and there was no kyphosis. The curve types included PUMC Ⅰ b in 2 cases, Ⅰ c in 2 cases, Ⅱ a in 3 cases, Ⅱ b2 in 3 cases, Ⅱ c1 in 3 cases, Ⅱ d1 in 17 cases and Ⅲb in 3 eases. All cases used pedicle screw fixation. Radiographic measurements included trunk shift (TS), lowest instrumented vertebrae tilting (LIVT), LIV distal disc angulation (LIVA) on the standing anterio-posterior ra-diographs before and after surgery and at the final follow-up. The difference of fusion levels were also recorded. The data were checked for normality and equal variances, and the level of significance was set at P<0.05. Results The TS was (1.87±1.18) cm before surgery and (0.97±0.69) cm at the final follow-up (t= 3.24, P=0.004). The LIVT was corrected from 20.95°±7.51° before surgery to 4.57°±2.80° at the final follow-up with a correction rate of 76.2%(t=10.10,P<0.001). The LIVA was 4.90°±3.83° before surgery and 5.43°± 2.23° at the final follow-up (t=0.14, P=0.626). Compared to fusion to the stable vertebrae, fusion to the touched vertebrae saved 1.14±0.73 mobile segments. Conclusion Fusion acording to this LIV criteria can achieve a good radiologic results and can save more mobile segments. Key words: Scoliosis; Adolescent; Spinal fusion

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