Research Day
RADIOGRAPHIC OUTCOMES OF SPINAL FUSION FOR ADOLESCENT IDIOPATHIC SCOLIOSIS WITH LOWEST INSTRUMENTED VERTEBRA AT THE THORACOLUMBAR JUNCTION.
Document Type
Abstract
Date
2021
Abstract
Introduction: Selective thoracic fusion (STF) is a technique used in adolescent idiopathic scoliosis (AIS). Compared to longer fusions, STF preserves mobility of the lumbar spine. Concern remains that stopping fusions near the thoracolumbar junction could lead to junctionalkyphosis, curve progression, and need for future revision.
Objective: Evaluate radiographic outcomes and reoperation rate for patients with AIS treated with posterior spinal fusion and lowest instrumented vertebra (LIV) near the thoracolumbar junction. Methods The WMed orthopedic spine surgery database was queried for patients with AIS and LIV between T11-L1. De-identified data were evaluated for optimal correction of lumbar curve (Cobb angle below fusion<26°), magnitude of lumbar curve progression from first to last post-operative radiograph, and need for further surgery.
Results: Ten patients were identified; three with a LIV at T11, five at T12, and two at L1. Optimal post-operative lumbar curve correction was achieved in 7/10 patients. One patient had lumbar curve progression from 45° to 55° treated with revision surgery extending the fusion to L4. The remaining 90% of patients did not have clinically significant progression of curves above or below the fusion and did not require revision surgery.
Conclusion: This small retrospective cohort analysis demonstrates overall good radiographic outcomes and low risk of revision surgery at short term follow up for AIS patients treated with posterior spinal fusion ending at the thoracolumbar junction. Further long-term study is needed to determine clinical and patient-reported outcomes to evaluate the safety of ending long fusions at the thoracolumbar junction.