Selecting the C7-LIV Line Vertebra as the Upper Instrumented Vertebra for Adolescent Idiopathic Scoliosis Lenke Type 1A Curves

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Abstract
Study Design. Retrospective multicenter cohort study Objective. We evaluated a new upper instrumented vertebra (UIV) selection method that used the modified Shinshu line (MSL) to establish the selected UIV as the MSL vertebra (MSLV). Summary of Background Data. No reports have addressed optimal UIV selection according to the lower instrumented vertebra (LIV) for good trunk balance in Lenke 1A curves. Methods. Forty-five consecutive patients (44 female, 14.4 ± 2.4 years) receiving posterior spinal fusion (PSF) for a Lenke 1A adolescent idiopathic scoliosis (AIS) curve were analyzed. We defined the novel MSL as the line between the center of the spinous process of C7 and that of the spinous process of the LIV. The vertebral body with which the MSL first contacted proximally was defined as the MSLV. The groups in which the UIV was at, proximal to, or distal to the MSLV were defined as the matched group (M-group; 15 cases [15 female], 14.7 ± 2.1 years), proximal group (P-group; 20 cases, [19 female], 15.0 ± 2.2 years), and distal group (D-group; 10 case [10 female], 14.8 ± 2.5 years), respectively. We measured Cobb angle, main thoracic (MT) curve correction rate and C7 plumb line absolute value (C7PL) at pre- and 2 years postoperatively for comparisons using Dunnett's test, with the M-group as the control. Results. In the M-group, P-group, and D-group, the Cobb angle correction rate between pre- and postoperative time points were 65.3 ± 1.3%, 62.4 ± 1.6%, and 52.8 ± 6.8%, respectively, and comparable apart from a smaller correction tendency in the D-group versus the M-group (P = 0.08). At 2 years postoperatively, C7PL was 0.5 ± 0.4 cm, 1.0 ± 0.6 cm, and 1.3 ± 0.9 cm, respectively, and significantly smaller for the M-group (both P < 0.05). Conclusions. Better trunk balance were obtained without reducing correction rate by setting the novel MSLV as the UIV in PSF for Lenke type 1A curves. Level of Evidence: 3

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