Selective versus nonselective fusion for idiopathic scoliosis: does lumbosacral takeoff angle change?
dc.contributor.author | Abel, Mark F | |
dc.contributor.author | Herndon, Stephanie K | |
dc.contributor.author | Sauer, Lindsay D | |
dc.contributor.author | Novicoff, Wendy M | |
dc.contributor.author | Smith, Justin S | |
dc.contributor.author | 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 | |
dc.date.updated | 2023-10-11T18:31:56Z | |
dc.description.abstract | Study designRetrospective review of a prospective, multicentered database.ObjectiveTo determine the relationship between preoperative lumbosacral takeoff angle (LSTOA) and postoperative thoracolumbar/lumbar Cobb angle (TL/L Cobb angle) in patients undergoing selective thoracic fusionsSummary of background dataSelective 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.MethodsPatients 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.ResultsPositive, 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).ConclusionCollectively, 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 | |
dc.identifier.issn | 1528-1159 | |
dc.identifier.uri | ||
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 | |
dc.subject | Lumbosacral Region | |
dc.subject | Lumbar Vertebrae | |
dc.subject | Thoracic Vertebrae | |
dc.subject | Humans | |
dc.subject | Kyphosis | |
dc.subject | Lordosis | |
dc.subject | Scoliosis | |
dc.subject | Radiography | |
dc.subject | Spinal Fusion | |
dc.subject | Postoperative Period | |
dc.subject | Linear Models | |
dc.subject | Retrospective Studies | |
dc.subject | Follow-Up Studies | |
dc.subject | Time Factors | |
dc.subject | Adolescent | |
dc.subject | Child | |
dc.subject | Preoperative Period | |
dc.subject | 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 | |
pubs.organisational-group | School of Medicine | |
pubs.organisational-group | Clinical Science Departments | |
pubs.organisational-group | Orthopaedic Surgery | |
pubs.organisational-group | Neurosurgery | |
pubs.publication-status | Published | |
pubs.volume | 36 |
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