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Purpose <p>Nonselective fusion for adolescent idiopathic scoliosis results in greater correction of the Lumbosacral Takeoff Angle (LSTOA); however, there are patients selectively fused that still have considerable change in their LSTOA. We sought to identify the relationship between preoperative LSTOA flexibility and postoperative correction of the LSTOA.</p> Methods <p>This was a retrospective analysis of Lenke 1–6, lumbar B and C modifier patients in the Harms Study Group with 2-year follow-up. Only patients with a lumbar Cobb angle ≥ 38 and ≤ 56 were included. The cases were divided into selective (SF: 177) and nonselective fusions (NSF: 324). Multivariate regression analysis was used to identify independent preoperative factors associated with postoperative LSTOA, and postoperative LSTOA correction in the NSF and SF groups.</p> Results <p>The mean postoperative LSTOA correction was 6.1 ± 3.8, with 75 (15%) patients experiencing postoperative worsening of their LSTOA. Among other variables, larger LSTOA (p &lt; 0.001) and smaller bending LSTOA correction (p &lt; 0.001) were predictors of larger postoperative LSTOAs in both groups. Among other variables, larger LSTOA (p &lt; 0.001), and larger bending LSTOA correction (p &lt; 0.01) were predictors of greater LSOTA correction in both groups. Satisfactory LSTOA correction in the selective fusion group was associated with larger preoperative LSTOA (p &lt; 0.001), larger bending LSTOA correction (p &lt; 0.001), larger lumbar Cobb angle bending correction (p: 0.034), and smaller lumbar apex to LIV distance (p: 0.003).</p> Conclusions <p>Preoperative static and bending LSTOA measurements may help surgeons decide between selective and non-selective fusion in patients with AIS.</p> <p><b>Level of evidence:</b> 3</p>

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Impact of preoperative lumbosacral takeoff flexibility on postoperative correction following spinal fusion for adolescent idiopathic scoliosis: a new consideration for selective thoracic fusion

  • 期刊论文

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  • 发表日期：

    2025年3月13日

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  • Richard E. Campbell,
  • Theodore Rudic,
  • Alexander Hafey,
  • Elizabeth Driskill,
  • Peter O. Newton,
  • Keith R. Bachmann,
  • A Noelle Larson,
  • Aaron Buckland,
  • Ahmet Alanay,
  • Amer Samdani,
  • Amit Jain,
  • Baron Lonner,
  • Benjamin Roye,
  • Burt Yaszay,
  • Caglar Yilgor,
  • Dan Hoernschmeyer,
  • Daniel Hedequist,
  • Daniel Sucato,
  • David Clements,
  • Firoz Miyanji,
  • Harry Shufflebarger,
  • Jack Flynn,
  • Jean Marc Mac Thiong,
  • Josh Murphy,
  • Joshua Pahys,
  • Kevin Neal,
  • Laurel Blakemore,
  • Lawrence Haber,
  • Lawrence Lenke,
  • Mark Abel,
  • Mark Erickson,
  • Michael Glotzbecker,
  • Michael Kelly,
  • Michael Vitale,
  • Michelle Marks,
  • Munish Gupta,
  • Nicholas Fletcher,
  • Patrick Cahill,
  • Paul Sponseller,
  • Peter Gabos,
  • Peter Newton,
  • Peter Sturm,
  • Randal Betz,
  • Robert H Cho,
  • Stefan Parent,
  • Stephen George,
  • Steven Hwang,
  • Suken Shah,
  • Sumeet Garg,
  • Tom Errico,
  • Vidyadhar Upasani

摘要

Purpose

Nonselective fusion for adolescent idiopathic scoliosis results in greater correction of the Lumbosacral Takeoff Angle (LSTOA); however, there are patients selectively fused that still have considerable change in their LSTOA. We sought to identify the relationship between preoperative LSTOA flexibility and postoperative correction of the LSTOA.

Methods

This was a retrospective analysis of Lenke 1–6, lumbar B and C modifier patients in the Harms Study Group with 2-year follow-up. Only patients with a lumbar Cobb angle ≥ 38 and ≤ 56 were included. The cases were divided into selective (SF: 177) and nonselective fusions (NSF: 324). Multivariate regression analysis was used to identify independent preoperative factors associated with postoperative LSTOA, and postoperative LSTOA correction in the NSF and SF groups.

Results

The mean postoperative LSTOA correction was 6.1 ± 3.8, with 75 (15%) patients experiencing postoperative worsening of their LSTOA. Among other variables, larger LSTOA (p < 0.001) and smaller bending LSTOA correction (p < 0.001) were predictors of larger postoperative LSTOAs in both groups. Among other variables, larger LSTOA (p < 0.001), and larger bending LSTOA correction (p < 0.01) were predictors of greater LSOTA correction in both groups. Satisfactory LSTOA correction in the selective fusion group was associated with larger preoperative LSTOA (p < 0.001), larger bending LSTOA correction (p < 0.001), larger lumbar Cobb angle bending correction (p: 0.034), and smaller lumbar apex to LIV distance (p: 0.003).

Conclusions

Preoperative static and bending LSTOA measurements may help surgeons decide between selective and non-selective fusion in patients with AIS.

Level of evidence: 3