Selective versus nonselective fusion for idiopathic scoliosis: does lumbosacral takeoff angle change?

dc.contributor.author

Abel, Mark F

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Herndon, Stephanie K

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Sauer, Lindsay D

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Novicoff, Wendy M

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Smith, Justin S

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Shaffrey, Christopher I

dc.contributor.author

Spinal Deformity Study Group

dc.date.accessioned

2023-10-11T18:31:57Z

dc.date.available

2023-10-11T18:31:57Z

dc.date.issued

2011-06

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2023-10-11T18:31:56Z

dc.description.abstract

Study design

Retrospective review of a prospective, multicentered database.

Objective

To determine the relationship between preoperative lumbosacral takeoff angle (LSTOA) and postoperative thoracolumbar/lumbar Cobb angle (TL/L Cobb angle) in patients undergoing selective thoracic fusions

Summary of background data

Selective fusion of the thoracic curve can improve the lumbar curve inpatients with idiopathic thoracic scoliosis and a compensatory lumbar curve. Predicting improvement is controversial and determining whether to perform a selective fusion or nonselective fusion can be difficult.

Methods

Patients had undergone either nonselective or selective spinal fusion for adolescent or juvenile idiopathic scoliosis (Lenke 1B/3B/1C/3C). Outcome measures were: coronal and sagittal thoracic Cobb angle, TL/L Cobb angles, lumbar apical vertebral translation, LSTOA and coronal decompensation. Analyses compared relationships between preoperative and postoperative radiographic measures.

Results

Positive, significant correlations were found between preoperative LSTOA and preoperative TL/L Cobb angle in the nonselective (r=0.7; P<0.001) and selective (r=0.5; P<0.001) fusion groups. Mean two-year postoperative coronal TL/L Cobb angles were significantly improved in nonselective and selective fusion groups (32° and 20°, respectively, P<0.001). In the nonselective fusion group, LSTOA significantly decreased by 11° (P<0.001), and in the selective group, the LSTOA had a modest but significant decrease of 2° (P<0.001). The nonselective fusion also resulted in more lordosis between T10 and L2 (7.5° of lordosis) than the selective approach (2.7° kyphosis, P<0.001). For both groups, upper thoracic kyphosis increased after surgery (P<0.001, P<0.001). For nonselective fusions, regression modeling predicted TL/L Cobb angle at two-year follow-up based on preoperative TL/L Cobb angle and preoperative LSTOA (r=0.4, P<0.001).

Conclusion

Collectively, these data demonstrate the preoperative TL/L Cobb angle and LSTOA can be useful predictors of postoperative TL/L Cobb angle after a selective instrumented fusion. Analyses of distal fixation levels demonstrated that to appreciably change the LSTOA using a posterior instrumented fusion, the distal level of fixation must be beyond the lumbar apex.
dc.identifier.issn

0362-2436

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1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/29240

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

dc.relation.isversionof

10.1097/brs.0b013e3181f60b5b

dc.subject

Spinal Deformity Study Group

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Lumbosacral Region

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Lumbar Vertebrae

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Thoracic Vertebrae

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Humans

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Kyphosis

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Lordosis

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Scoliosis

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Radiography

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Spinal Fusion

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Postoperative Period

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Linear Models

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Retrospective Studies

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Follow-Up Studies

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Time Factors

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Adolescent

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Child

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Preoperative Period

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Outcome Assessment, Health Care

dc.title

Selective versus nonselective fusion for idiopathic scoliosis: does lumbosacral takeoff angle change?

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

1103

pubs.end-page

1112

pubs.issue

14

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

36

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