Simultaneous Hypercorrection of Lowest Instrumented Vertebral Tilt and Main Thoracic Curve is Associated With Progression of Residual Lumbar Curve in Adolescent Idiopathic Scoliosis

Study Design. A retrospective cohort study. Objective. To determine radiographic parameters, including the lowest instrumented vertebral (LIV) tilt, related to the postoperative magnitude and progression of residual lumbar curves (LCs) in adolescent idiopathic scoliosis patients who underwent posterior spinal fusion with LIV at or above L1. Summary of Background Data. Although several guidelines have been proposed for thoracic curve fusion, factors related to the postoperative magnitude and potential progression of unfused LCs remained undetermined. The effect of the LIV tilt on residual LCs is also unclear. Materials and Methods. Patients with Lenke type 1 to 4 curves who underwent posterior spinal fusion with LIV at or above L1 with a minimum follow-up period of 2 years were evaluated. Prediction models for residual LCs were developed using multivariate linear regressions with selected radiographic parameters. Subgroup analyses, followed by sensitivity tests, were then performed for variables best predicting the progression of residual LCs. Results. A total of 130 patients were included. Multivariate linear regression analysis showed that the immediate postoperative LIV-tilt angle was associated with the immediate postoperative LCs and the prediction model for residual LCs, with high accuracy (R=0.93 and 0.77, respectively). Sensitivity tests revealed immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53% as predictors for progression of residual LCs, and they reached moderate discrimination when combined together as one criterion (odds ratio=16.3, 95% confidence interval=5.3-50.1; sensitivity=89%, specificity=67%, positive predicted value=51%, negative predicted value=94%). Conclusion. The current study revealed that LIV tilt, as an operable factor during surgery, is not only a determinant in prediction models showing high correlation with the magnitude of postoperative LCs but a predictor for progression of residual LCs. "Immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53%,"as a united criterion, could serve as a predictor for progression of residual LCs.