RELATED FACTORS ANALYSIS OF DISTAL ADDING-ON PHENOMENON IN MAJOR THORACIC CURVE AFTER POSTERIOR SELECTIVE FUSION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHIJianxiong , YEFeng , ZHOUYue , HUANGBo , QIUHao ,  CHUTongwei

Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, 400038, P. R. China;

Corresponding?author：

CHUTongwei, Email: chtw@sina.com

Keywords：

Adolescent idiopathic scoliosis; Selective fusion; Type Lenke 1A; Adding-on phenomenon

DOI：

10.7507/1002-1892.20160257

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Objective To identify the prevalence of distal adding-on phenomenon after posterior selective fusion in type Lenke 1A idiopathic scoliosis, to analyze its risk factors so as to find the reasonable choice for lowest instrumented vertebra (LIV). Methods A retrospective study was made on the clinical data of 43 patients with type Lenke 1A idiopathic scoliosis undergoing posterior selection fusion with pedicle screw instrumentation between July 2011 and December 2015. There were 15 males and 28 females, aged 12-18 years (mean, 16 years). The preoperative Cobb angle was (50.1±11.3)°. The anteroposterior and lateral radiographs were taken at preoperation, immediate after operation, and last follow-up to measure the radiographic parameters. Forty-three patients were divided into adding-on group and control group according to whether or not the occurrence of distal adding-on phenomenon on anteroposterior radiographs of the spine at last follow-up. All the factors that maybe cause distsal adding-on were evaluated by statistical analysis. Results The patients were followed up 12-50 months (mean, 26.5 months). At last follow-up, distal adding-on was observed in 10 of 43 patients (23.3%), including 2 males (13.3%) and 8 females (28.6%). Univariate analyses showed following several factors associated with adding-on:preoperative lumbar flexibility, preoperative pelvic tilt in coronal plane, preoperative LIV+1 deviation from center sacral vertical line, L₄ subtype, the difference between LIV and last touching vertebra (LTV) (LIV-LTV), the difference between LIV and lower end vertebra (LEV) (LIV-LEV), and the difference between LIV and stable vertebra (SV) (LIV-SV). The risk factors above were brought into Logistic regression model, the results showed that preoperative LIV+1 deviation (deviation>10 mm, odds ratio=10.812, P=0.026), LIV-LTV (LIV-LTV<1, odds ratio=9.017, P=0.04), and L₄ subtype (1A-R, odds ratio=9.744, P=0.047) were significantly associated with adding-on. Conclusion Preoperative LIV+1 deviation of >10 mm, L₄ subtype (1A-R) and LIV-LTV of <1 are independent predictive factors of adding-on after surgery. As high risk of adding-on was closely related with the incorrect fusion level, it plays an important role for surgeons to decide the level of the fusion before surgery thoroughly. The LIV should be extended at least to LTV+1 to avoid adding-on phenomenon.

Citation： SHI Jianxiong, YE Feng, ZHOU Yue, HUANG Bo, QIU Hao, CHU Tongwei. RELATED FACTORS ANALYSIS OF DISTAL ADDING-ON PHENOMENON IN MAJOR THORACIC CURVE AFTER POSTERIOR SELECTIVE FUSION. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(10): 1258-1263. doi: 10.7507/1002-1892.20160257 Copy

1.	Lehman RA Jr, Lenke LG, Keeler KA, et al. Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs:minimum three-year follow-up of one hundred fourteen cases. Spine (Phila Pa 1976), 2008, 33(14):1598-1604.
2.	Matsumoto M, Watanabe K, Hosogane N, et al. Postoperative distal adding-on and related factors in Lenke type 1A curve. Spine (Phila Pa 1976), 2013, 38(9):737-744.
3.	Suk SI, Lee SM, Chung ER, et al. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976), 2003, 28(5):484-891.
4.	Wang Y, Hansen ES, Hoy K, et al. Distal adding-on phenomenon in Lenke 1A scoliosis:risk factor identification and treatment strategy comparison. Spine (Phila Pa 1976), 2011, 36(14):1113-1122.
5.	Studer D, Awais A, Williams N, et al. Selective fusion in adolescent idiopathic scoliosis:a radiographic evaluation of risk factors for imbalance. J Child Orthop, 2015, 9(2):153-160.
6.	Wang Y, Bunger CE, Zhang Y, et al. Distal adding-on in Lenke 1A scoliosis:how to more effectively determine the onset of distal adding-on. Spine (Phila Pa 1976), 2013, 38(6):490-495.
7.	Cho RH, Yaszay B, Bartley CE, et al. Which Lenke 1A curves are at the greatest risk for adding-on... and why. Spine (Phila Pa 1976), 2012, 37(16):1384-1390.
8.	Cao K, Watanabe K, Hosogane N, et al. Association of postoperative shoulder balance with adding-on in Lenke Type Ⅱ adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2014, 39(12):E705-712.
9.	Parisini P, Di Sliverstre M, Lolli F, et al. Selective thoracic surgery in the Lenke type 1A:King Ⅲ and King IV type curves. Eur Spine J, 2009, 18 Suppl 1:82-88.
10.	劉臻, 邱勇, 朱澤章, 等. Lenke1型特發性脊柱側凸選擇性胸彎融合時的下端融合椎選擇:T₁₂還是L₁. 中國矯形外科雜志, 2012, 20(21):1921-1925.
11.	耿翔, 王孝賓, 呂國華, 等. Lenke 1A型青少年特發性脊柱側凸患者胸彎融合術后附加現象的原因分析. 中國脊柱脊髓雜志, 2013, 23(7):622-627.
12.	Suk SI, Lee SM, Chung ER, et al. Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis:more than 5-year follow-up. Spine (Phila Pa 1976), 2005, 30(14):1602-1609.
13.	Lakhal W, Loret JE, de Bodman C, et al. The progression of lumbar curves in adolescent Lenke 1 scoliosis and the distal adding-on phenomenon. Orthop Traumatol Surg Res, 2014, 100(4 Suppl):S249-254.
14.	Sarlak AY, Atmaca H, Kim WJ, et al. Radiographic features of the Lenke 1A curves to help to determine the optimum distal fusion level selection. Spine (Phila Pa 1976), 2011, 36(19):1592-1599.
15.	孫旭, 邱勇, 孫超, 等. 特發性胸椎側凸選擇性融合術后遠端疊加現象. 中國脊柱脊髓雜志, 2013, 23(2):103-108.
16.	Potter BK, Rosner MK, Lehman RA, et al. Reliability of end, neutral, and stable vertebrae identification in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2005, 30(14):1658-1663.
17.	Svanholm H, Starklint H, Gundersen HJ, et al. Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic. APMIS, 1989, 97(8):689-698.
18.	Yang C, Li Y, Yang M, et al. Adding-on phenomenon after surgery in Lenke Type 1, 2 Adolescent Idiopathic Scoliosis:is it predictable. Spine (Phila Pa 1976), 2016, 41(8):698-704.

1. Lehman RA Jr, Lenke LG, Keeler KA, et al. Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs:minimum three-year follow-up of one hundred fourteen cases. Spine (Phila Pa 1976), 2008, 33(14):1598-1604.
2. Matsumoto M, Watanabe K, Hosogane N, et al. Postoperative distal adding-on and related factors in Lenke type 1A curve. Spine (Phila Pa 1976), 2013, 38(9):737-744.
3. Suk SI, Lee SM, Chung ER, et al. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976), 2003, 28(5):484-891.
4. Wang Y, Hansen ES, Hoy K, et al. Distal adding-on phenomenon in Lenke 1A scoliosis:risk factor identification and treatment strategy comparison. Spine (Phila Pa 1976), 2011, 36(14):1113-1122.
5. Studer D, Awais A, Williams N, et al. Selective fusion in adolescent idiopathic scoliosis:a radiographic evaluation of risk factors for imbalance. J Child Orthop, 2015, 9(2):153-160.
6. Wang Y, Bunger CE, Zhang Y, et al. Distal adding-on in Lenke 1A scoliosis:how to more effectively determine the onset of distal adding-on. Spine (Phila Pa 1976), 2013, 38(6):490-495.
7. Cho RH, Yaszay B, Bartley CE, et al. Which Lenke 1A curves are at the greatest risk for adding-on... and why. Spine (Phila Pa 1976), 2012, 37(16):1384-1390.
8. Cao K, Watanabe K, Hosogane N, et al. Association of postoperative shoulder balance with adding-on in Lenke Type Ⅱ adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2014, 39(12):E705-712.
9. Parisini P, Di Sliverstre M, Lolli F, et al. Selective thoracic surgery in the Lenke type 1A:King Ⅲ and King IV type curves. Eur Spine J, 2009, 18 Suppl 1:82-88.
10. 劉臻, 邱勇, 朱澤章, 等. Lenke1型特發性脊柱側凸選擇性胸彎融合時的下端融合椎選擇:T₁₂還是L₁. 中國矯形外科雜志, 2012, 20(21):1921-1925.
11. 耿翔, 王孝賓, 呂國華, 等. Lenke 1A型青少年特發性脊柱側凸患者胸彎融合術后附加現象的原因分析. 中國脊柱脊髓雜志, 2013, 23(7):622-627.
12. Suk SI, Lee SM, Chung ER, et al. Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis:more than 5-year follow-up. Spine (Phila Pa 1976), 2005, 30(14):1602-1609.
13. Lakhal W, Loret JE, de Bodman C, et al. The progression of lumbar curves in adolescent Lenke 1 scoliosis and the distal adding-on phenomenon. Orthop Traumatol Surg Res, 2014, 100(4 Suppl):S249-254.
14. Sarlak AY, Atmaca H, Kim WJ, et al. Radiographic features of the Lenke 1A curves to help to determine the optimum distal fusion level selection. Spine (Phila Pa 1976), 2011, 36(19):1592-1599.
15. 孫旭, 邱勇, 孫超, 等. 特發性胸椎側凸選擇性融合術后遠端疊加現象. 中國脊柱脊髓雜志, 2013, 23(2):103-108.
16. Potter BK, Rosner MK, Lehman RA, et al. Reliability of end, neutral, and stable vertebrae identification in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2005, 30(14):1658-1663.
17. Svanholm H, Starklint H, Gundersen HJ, et al. Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic. APMIS, 1989, 97(8):689-698.
18. Yang C, Li Y, Yang M, et al. Adding-on phenomenon after surgery in Lenke Type 1, 2 Adolescent Idiopathic Scoliosis:is it predictable. Spine (Phila Pa 1976), 2016, 41(8):698-704.

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RELATED FACTORS ANALYSIS OF DISTAL ADDING-ON PHENOMENON IN MAJOR THORACIC CURVE AFTER POSTERIOR SELECTIVE FUSION

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