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Erschienen in:
01.01.2016 | Original Article • SPINE - PAEDIATRICS
Predictive factors for a distal adjacent disorder with L3 as the lowest instrumented vertebra in Lenke 5C patients
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 1/2016
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Objective
To investigate what type of Lenke 5C patient benefits most from a fusion to L3 as the LIV.
Methods
The subjects were 16 patients who underwent fusion surgery to L3 as the lowest instrumented vertebra (LIV), and who were then observed for a minimum of 2 years postoperatively. We considered an unsatisfactory radiologic outcome for the distal adjacent curve (DAD) to be an L3 or L4 tilt angle less than 10° or L3/4 disc wedging less than 10°. Patients were divided into 2 groups based on the radiologic outcome of the distal curve: the distal adjacent disorder+ (DAD+) and the distal adjacent disorder− (DAD−). We compared global balance, Cobb angles (thoracic and lumbar), L3 and L4 tilt angles and L3/4/5 disc angles between the 2 groups on preoperative, postoperative and final radiographs.
Results
Seven patients (43.8 %) met the criteria for the DAD+ group. On preoperative radiographs, there was a significant difference in the L3/4 disc angle: the DAD+ group opened to the preoperative convex side (−2.1° ± 3.0°) and the DAD− group opened to the preoperative concave side (4.7° ± 5.1°). The standing L3- and L4-CSVL and the L4-CSVL under traction were significantly different.
Conclusions
In Lenke 5C patients who underwent fusion surgery to L3 as the LIV, preoperative LIV (L3), LIV + 1 (L4) translation and L3/4 disc angle on standing, plus LIV + 1 translation under traction were very important parameters correlating with postoperative global coronal balance.