Using side-bending radiographs to determine the distal fusion level in patients with single thoracic idiopathic scoliosis undergoing posterior correction with pedicle screws.

Study Design: Prospective.

Objectives: To evaluate a strategy to determine the distal fusion level in posterior pedicle screw correction of single thoracic idiopathic scoliosis.

Summary Of Background Data: No standard method for selecting the lowest instrumented vertebra (LIV) for the correction of thoracic adolescent idiopathic scoliosis with posterior all-pedicle screw instrumentations exists.

Methods: Thirty-eight patients with single right thoracic (Lenke 1A) adolescent idiopathic scoliosis undergoing posterior pedicle screw fixation were studied. The LIV was determined using guidelines based on preoperative side-bending radiographs. In brief, (1) the whole thoracic Cobb curve should be included in the fusion mass, and the LIV should not be superior to the lower-end vertebra of the Cobb measurement. (2) On the right side-bending radiographs, the LIV should be derotated to neutral in skeletally immature (Risser 0 to 3) patients and the disc immediately below the LIV must open on the left side by at least 5 degrees. (3) On the left side-bending radiographs, the disc immediately below the LIV must be open on the right side by at least 0 degree. The first segment meeting the criteria when proceeding from the lower-end vertebra caudally is chosen as the LIV. Outcomes were based on the standing radiographs.

Results: Minimum follow-up was 2 years. The mean preoperative thoracic curve was 48.4±9.2 degrees and 12.6±6.1 degrees at final follow-up, resulting in a mean correction of 74.7%±8.5%. The mean preoperative compensatory lumbar curve of 23.7±7.5 degrees was 6.3±4.8 degrees at final follow-up. A change in lumbar lordosis from -41.2±11.9 degrees preoperatively to -38.2±9.9 degrees at final follow-up occurred. All patients achieved coronal balance and no decompensation or adding-on phenomenon was observed. Compared with the recommended fusion end by the Harrington stable zone method, 86.9% patients were saved 1 or more motion segment.

Conclusions: The method described was effective in obtaining satisfactory curve correction, adequate trunk balance, and preservation of motion segments.