The Impact of the Lowest Instrumented Vertebra on the Correction of the Minor Curve During Selective Fusion in Patients With Adolescent Idiopathic Scoliosis

Abstract

Study Design: Retrospective single-center data analysis. Objective: The aim of this investigation was to give advises for choosing the LIV in selective fusion to reach the best correction of the minor curve and sagittal profile. Summary of Background Data: Scoliotic curves can be classified as structural or nonstructural. If selective fusion is performed, the nonstructural curves are not instrumented. The choice of the lowest instrumented vertebra (LIV) and the impact of different levels of the LIV on the correction of the minor curve in the frontal profile and on the sagittal balance is under debate. Methods: Forty-seven consecutive patients treated by posterior instrumented fusion were included in this retrospective investigation. Impact of the level of the LIV with regard to distance to end vertebra (EV), to the stable vertebra (StV), to the sagittal infliction point (IP), and to the apex of the lumbar lordosis on the correction of the minor curve was analyzed. Results: Distance of LIV to EV was significant with regard to correction of the minor curve if it was more than 5 levels (P<0.001). Distance of LIV to StV was significant with regard to correction of the minor curve if it was more than 4 levels (P<0.01). Distance of LIV to IP was significant with regard to correction of the minor curve if it was more than 2 levels (P<0.01). Conclusions: Choosing a LIV that was more than 2 levels higher or lower than the sagittal infliction point showed a significantly higher correction of the minor curve. We therefore recommend to keep that distance when LIV is chosen.