Li Chenkai, Ye Xiaohan, Zhang Haoran, Yang Yang, Du You, Zhao Yiwei, Wang Shengru, Zhang Jianguo
Department of Orthopedics, Peking Union Medical College Hospital, Beijing, P. R. China.
Orthop Surg. 2025 Jan;17(1):105-114. doi: 10.1111/os.14267. Epub 2024 Oct 17.
There has been no definitive conclusion on the selection of the lowest instrumented vertebra (LIV) in Lenke 5C adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to evaluate whether it is enough to stop distal fusion at L3 in mild to moderate Lenke 5C AIS patients with posterior selective lumbar fusion, Ponte osteotomies and segmental direct vertebra rotation and to analyze the risk factors for postoperative complications in patients selecting L3 as the LIV.
A retrospective review was conducted on 106 Lenke 5C AIS patients who underwent corrective surgery in our institution from 2010 to 2021, with a minimum 2-year follow-up. The LIV was L3 or L4. According to the LIV, patients were initially divided into Group I (the LIV was L3) and Group II (the LIV was L4). Then, Group I was further divided into a complication group and a non-complication group. Demographics, radiological parameters, postoperative complications, and clinical outcomes were recorded. Univariate analysis and multivariate logistic analysis were used to identify the risk factors for postoperative complications in patients with L3 as the LIV.
There were no significant differences in the demographics, radiological parameters, postoperative complications, or clinical outcomes between Group I and Group II (p > 0.05), and the outcomes were satisfactory in both groups. The main postoperative complications were distal adding-on (11 cases), coronal imbalance (16 cases), proximal junctional kyphosis (2 cases), and internal fixation failure (4 cases). Logistic regression analysis revealed that age and postoperative C7-CSVL were independent predictors of postoperative complications when selecting L3 as the LIV.
Terminating the distal fusion level at L3 was practical for mild to moderate Lenke 5C AIS patients. For patients selecting L3 as the LIV, younger patients should be cautious, and maintaining postoperative coronal balance is necessary for avoiding postoperative complications.
对于Lenke 5C型青少年特发性脊柱侧凸（AIS）患者最低融合椎体（LIV）的选择，目前尚无定论。本研究的目的是评估在轻度至中度Lenke 5C型AIS患者中，采用后路选择性腰椎融合、 Ponte截骨术和节段性直接椎体旋转术时，将远端融合止于L3是否足够，并分析选择L3作为LIV的患者术后并发症的危险因素。
对2010年至2021年在本机构接受矫正手术的106例Lenke 5C型AIS患者进行回顾性研究，随访时间至少2年。LIV为L3或L4。根据LIV，患者最初分为I组（LIV为L3）和II组（LIV为L4）。然后，I组进一步分为并发症组和无并发症组。记录人口统计学资料、影像学参数、术后并发症和临床结果。采用单因素分析和多因素logistic分析确定以L3为LIV的患者术后并发症 的危险因素。
I组和II组在人口统计学资料、影像学参数、术后并发症或临床结果方面无显著差异（p>0.05），两组结果均令人满意。术后主要并发症为远端附加（11例）、冠状面失衡（16例）、近端交界性后凸（2例）和内固定失败（4例）。logistic回归分析显示，年龄和术后C7-CSVL是选择L3作为LIV时术后并发症的独立预测因素。
对于轻度至中度Lenke 5C型AIS患者，将远端融合水平止于L3是可行的。对于选择L3作为LIV的患者，年轻患者应谨慎，保持术后冠状面平衡对于避免术后并发症是必要的。
