Postoperative distal adding-on and related factors in Lenke type 1A curve

Morio Matsumoto, Koota Watanabe, Naobumi Hosogane, Noriaki Kawakami, Taichi Tsuji, Koki Uno, Teppei Suzuki, Manabu Ito, Haruhisa Yanagida, Toru Yamaguchi, Shohei Minami, Tsutomu Akazawa

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Study Design: A retrospective, multicenter study. Objective: To investigate the occurrence of and factors related to postoperative adding-on in Lenke type 1A curve. Summary of Background Data: Although several studies have investigated factors associated with adding-on in Lenke type 1A curve, these factors have not been elucidated in a large study population. Methods: This study included 112 patients who were followed more than 2 years after undergoing selective posterior thoracic fusion surgery for Lenke Type 1A curve (8 males, 104 females; mean age at surgery, 16.1 yr; mean follow-up, 3.6 yr). The lower instrumented vertebra (LIV) was T12 in 22 patients, L1 in 55, L2 in 32, and L3 in 3. Distal to the main thoracic curve, the end vertebra, neutral vertebra, stable vertebra (SV), and the last vertebra touching the central sacral vertical line (last touching vertebra, LTV) were determined. The occurrence and factors associated with distal adding-on were investigated. Results: The mean Cobb angle and apical translation of the main thoracic curve were 54.6 ° ± 9.6 ° and 53.1 ± 20.4 mm before surgery, and 14.2 ± 7.4 and 16.2 ± 12.7 at follow-up, respectively. Distal adding-on was observed in 21 patients (18.8%) at follow-up. Univariate analyses identifi ed several factors signifi cantly associated with adding-on, including the preoperative proximal thoracic curve, the apical translation of the main thoracic curve, Miyanji's subclassifi cation, the postsurgical proximal and main thoracic curves, the postsurgical apical translation of the main thoracic curve, the correction rate of the main thoracic curve and the clavicle angle immediately after surgery and at follow-up, and the difference in levels between the LIV and the end vertebra, neutral vertebra, LTV, and stable vertebra. Logistic regression analysis showed that the apical translation of the main thoracic curve immediately after surgery (apical translation > 25 mm, odds ratio: 10.7, 95% confi dence interval: 3.1-37.0, P = 0.001) and the difference in levels between LIV and LTV (LIV-LTV) (LIV-LTV < 0, odds ratio: 6.7, 95% confi dence interval: 1.9-23.9, P = 0.003) were signifi cantly associated with adding-on. Conclusion: Since the residual apical translation of the main thoracic curve and the lowest instrumented vertebra more cranial to the last touching vertebra were signifi cantly associated with addingon, surgeons may need to obtain the maximum reduction of the apical translation of the main thoracic curve and to extend the LIV at least to the LTV to avoid postoperative adding-on.

Original languageEnglish
Pages (from-to)737-744
Number of pages8
JournalSpine
Volume38
Issue number9
DOIs
Publication statusPublished - 2013 Apr 20

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Spine
Thorax
Odds Ratio
Clavicle
Thoracic Surgery
Multicenter Studies
Cations
Retrospective Studies

Keywords

  • Adding-on
  • Adolescent idiopathic scoliosis
  • Lenke type 1A

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Postoperative distal adding-on and related factors in Lenke type 1A curve. / Matsumoto, Morio; Watanabe, Koota; Hosogane, Naobumi; Kawakami, Noriaki; Tsuji, Taichi; Uno, Koki; Suzuki, Teppei; Ito, Manabu; Yanagida, Haruhisa; Yamaguchi, Toru; Minami, Shohei; Akazawa, Tsutomu.

In: Spine, Vol. 38, No. 9, 20.04.2013, p. 737-744.

Research output: Contribution to journalArticle

Matsumoto, M, Watanabe, K, Hosogane, N, Kawakami, N, Tsuji, T, Uno, K, Suzuki, T, Ito, M, Yanagida, H, Yamaguchi, T, Minami, S & Akazawa, T 2013, 'Postoperative distal adding-on and related factors in Lenke type 1A curve', Spine, vol. 38, no. 9, pp. 737-744. https://doi.org/10.1097/BRS.0b013e318279b666
Matsumoto, Morio ; Watanabe, Koota ; Hosogane, Naobumi ; Kawakami, Noriaki ; Tsuji, Taichi ; Uno, Koki ; Suzuki, Teppei ; Ito, Manabu ; Yanagida, Haruhisa ; Yamaguchi, Toru ; Minami, Shohei ; Akazawa, Tsutomu. / Postoperative distal adding-on and related factors in Lenke type 1A curve. In: Spine. 2013 ; Vol. 38, No. 9. pp. 737-744.
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abstract = "Study Design: A retrospective, multicenter study. Objective: To investigate the occurrence of and factors related to postoperative adding-on in Lenke type 1A curve. Summary of Background Data: Although several studies have investigated factors associated with adding-on in Lenke type 1A curve, these factors have not been elucidated in a large study population. Methods: This study included 112 patients who were followed more than 2 years after undergoing selective posterior thoracic fusion surgery for Lenke Type 1A curve (8 males, 104 females; mean age at surgery, 16.1 yr; mean follow-up, 3.6 yr). The lower instrumented vertebra (LIV) was T12 in 22 patients, L1 in 55, L2 in 32, and L3 in 3. Distal to the main thoracic curve, the end vertebra, neutral vertebra, stable vertebra (SV), and the last vertebra touching the central sacral vertical line (last touching vertebra, LTV) were determined. The occurrence and factors associated with distal adding-on were investigated. Results: The mean Cobb angle and apical translation of the main thoracic curve were 54.6 ° ± 9.6 ° and 53.1 ± 20.4 mm before surgery, and 14.2 ± 7.4 and 16.2 ± 12.7 at follow-up, respectively. Distal adding-on was observed in 21 patients (18.8{\%}) at follow-up. Univariate analyses identifi ed several factors signifi cantly associated with adding-on, including the preoperative proximal thoracic curve, the apical translation of the main thoracic curve, Miyanji's subclassifi cation, the postsurgical proximal and main thoracic curves, the postsurgical apical translation of the main thoracic curve, the correction rate of the main thoracic curve and the clavicle angle immediately after surgery and at follow-up, and the difference in levels between the LIV and the end vertebra, neutral vertebra, LTV, and stable vertebra. Logistic regression analysis showed that the apical translation of the main thoracic curve immediately after surgery (apical translation > 25 mm, odds ratio: 10.7, 95{\%} confi dence interval: 3.1-37.0, P = 0.001) and the difference in levels between LIV and LTV (LIV-LTV) (LIV-LTV < 0, odds ratio: 6.7, 95{\%} confi dence interval: 1.9-23.9, P = 0.003) were signifi cantly associated with adding-on. Conclusion: Since the residual apical translation of the main thoracic curve and the lowest instrumented vertebra more cranial to the last touching vertebra were signifi cantly associated with addingon, surgeons may need to obtain the maximum reduction of the apical translation of the main thoracic curve and to extend the LIV at least to the LTV to avoid postoperative adding-on.",
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T1 - Postoperative distal adding-on and related factors in Lenke type 1A curve

AU - Matsumoto, Morio

AU - Watanabe, Koota

AU - Hosogane, Naobumi

AU - Kawakami, Noriaki

AU - Tsuji, Taichi

AU - Uno, Koki

AU - Suzuki, Teppei

AU - Ito, Manabu

AU - Yanagida, Haruhisa

AU - Yamaguchi, Toru

AU - Minami, Shohei

AU - Akazawa, Tsutomu

PY - 2013/4/20

Y1 - 2013/4/20

N2 - Study Design: A retrospective, multicenter study. Objective: To investigate the occurrence of and factors related to postoperative adding-on in Lenke type 1A curve. Summary of Background Data: Although several studies have investigated factors associated with adding-on in Lenke type 1A curve, these factors have not been elucidated in a large study population. Methods: This study included 112 patients who were followed more than 2 years after undergoing selective posterior thoracic fusion surgery for Lenke Type 1A curve (8 males, 104 females; mean age at surgery, 16.1 yr; mean follow-up, 3.6 yr). The lower instrumented vertebra (LIV) was T12 in 22 patients, L1 in 55, L2 in 32, and L3 in 3. Distal to the main thoracic curve, the end vertebra, neutral vertebra, stable vertebra (SV), and the last vertebra touching the central sacral vertical line (last touching vertebra, LTV) were determined. The occurrence and factors associated with distal adding-on were investigated. Results: The mean Cobb angle and apical translation of the main thoracic curve were 54.6 ° ± 9.6 ° and 53.1 ± 20.4 mm before surgery, and 14.2 ± 7.4 and 16.2 ± 12.7 at follow-up, respectively. Distal adding-on was observed in 21 patients (18.8%) at follow-up. Univariate analyses identifi ed several factors signifi cantly associated with adding-on, including the preoperative proximal thoracic curve, the apical translation of the main thoracic curve, Miyanji's subclassifi cation, the postsurgical proximal and main thoracic curves, the postsurgical apical translation of the main thoracic curve, the correction rate of the main thoracic curve and the clavicle angle immediately after surgery and at follow-up, and the difference in levels between the LIV and the end vertebra, neutral vertebra, LTV, and stable vertebra. Logistic regression analysis showed that the apical translation of the main thoracic curve immediately after surgery (apical translation > 25 mm, odds ratio: 10.7, 95% confi dence interval: 3.1-37.0, P = 0.001) and the difference in levels between LIV and LTV (LIV-LTV) (LIV-LTV < 0, odds ratio: 6.7, 95% confi dence interval: 1.9-23.9, P = 0.003) were signifi cantly associated with adding-on. Conclusion: Since the residual apical translation of the main thoracic curve and the lowest instrumented vertebra more cranial to the last touching vertebra were signifi cantly associated with addingon, surgeons may need to obtain the maximum reduction of the apical translation of the main thoracic curve and to extend the LIV at least to the LTV to avoid postoperative adding-on.

AB - Study Design: A retrospective, multicenter study. Objective: To investigate the occurrence of and factors related to postoperative adding-on in Lenke type 1A curve. Summary of Background Data: Although several studies have investigated factors associated with adding-on in Lenke type 1A curve, these factors have not been elucidated in a large study population. Methods: This study included 112 patients who were followed more than 2 years after undergoing selective posterior thoracic fusion surgery for Lenke Type 1A curve (8 males, 104 females; mean age at surgery, 16.1 yr; mean follow-up, 3.6 yr). The lower instrumented vertebra (LIV) was T12 in 22 patients, L1 in 55, L2 in 32, and L3 in 3. Distal to the main thoracic curve, the end vertebra, neutral vertebra, stable vertebra (SV), and the last vertebra touching the central sacral vertical line (last touching vertebra, LTV) were determined. The occurrence and factors associated with distal adding-on were investigated. Results: The mean Cobb angle and apical translation of the main thoracic curve were 54.6 ° ± 9.6 ° and 53.1 ± 20.4 mm before surgery, and 14.2 ± 7.4 and 16.2 ± 12.7 at follow-up, respectively. Distal adding-on was observed in 21 patients (18.8%) at follow-up. Univariate analyses identifi ed several factors signifi cantly associated with adding-on, including the preoperative proximal thoracic curve, the apical translation of the main thoracic curve, Miyanji's subclassifi cation, the postsurgical proximal and main thoracic curves, the postsurgical apical translation of the main thoracic curve, the correction rate of the main thoracic curve and the clavicle angle immediately after surgery and at follow-up, and the difference in levels between the LIV and the end vertebra, neutral vertebra, LTV, and stable vertebra. Logistic regression analysis showed that the apical translation of the main thoracic curve immediately after surgery (apical translation > 25 mm, odds ratio: 10.7, 95% confi dence interval: 3.1-37.0, P = 0.001) and the difference in levels between LIV and LTV (LIV-LTV) (LIV-LTV < 0, odds ratio: 6.7, 95% confi dence interval: 1.9-23.9, P = 0.003) were signifi cantly associated with adding-on. Conclusion: Since the residual apical translation of the main thoracic curve and the lowest instrumented vertebra more cranial to the last touching vertebra were signifi cantly associated with addingon, surgeons may need to obtain the maximum reduction of the apical translation of the main thoracic curve and to extend the LIV at least to the LTV to avoid postoperative adding-on.

KW - Adding-on

KW - Adolescent idiopathic scoliosis

KW - Lenke type 1A

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