title: Does the lower instrumented vertebra have an effect on lumbar mobility, subjective perception of trunk flexibility, and quality of life in patients with idiopathic scoliosis treated by spinal fusion?
abstract: METHODS
  Cross-sectional study in patients with idiopathic scoliosis treated with spinal fusion.
  
  
  OBJECTIVE
  To measure lumbar spine mobility in the study population; determine low back pain intensity (LBPi), subjective perception of trunk flexibility (TF), and quality of life using validated outcome instruments; and investigate correlations of the lower instrumented vertebra (LIV) with TF, LBPi, and quality of life.
  
  
  BACKGROUND
  The loss of range of motion resulting from spinal fusion might lead to low back pain, trunk rigidity, and a negative impact on quality of life. Nonetheless, these outcomes have not been conclusively demonstrated because lumbar mobility and LIV have not been correlated with validated outcome instruments.
  
  
  METHODS
  Forty-one patients (mean age, 27 y) with idiopathic scoliosis treated by spinal fusion (mean time since surgery, 135 mo) were included. Patients were assigned to 3 groups according to LIV level: group 1 (fusion to T12, L1, or L2) 14 patients; group 2 (fusion to L3) 13 patients, and group 3 (fusion to L4, L5, or S1) 14 patients. At midterm follow-up, patients completed the Scoliosis Research Society (SRS)-22 Questionnaire and Quality of Life Profile for Spine Deformities to evaluate perceived TF, and rated LBPi with a numerical scale. Lumbar mobility was assessed using a dual digital inclinometer.
  
  
  RESULTS
  Group 3 (fusion to L4, L5, or S1) showed statistically significant differences relative to the other groups, with less lumbar mobility and poorer scores for the SRS subtotal (P = 0.003) and SRS pain scale (P = 0.01). Nevertheless, LBPi and TF were similar in the 3 groups. TF correlated with SRS-22 subtotal (r = -0.38, P = 0.01) and pain scale (r = -0.42, P = 0.007) scores, and with LBPi (r = 0.43, P = 0.005).
  
  
  CONCLUSIONS
  LIV correlated moderately with lumbar mobility, health-related quality of life (SRS-22), and spinal pain (SRS-22 pain subscale), but not with intensity of pain in the lumbar area or perceived TF.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Sanchez-Raya
authors.forename: Juan
authors.initials: J
authors.lastname: Bago
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellise
authors.forename: Ampar
authors.initials: A
authors.lastname: Cuxart
authors.forename: Carlos
authors.initials: C
authors.lastname: Villanueva
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D017116:Low Back Pain / Q000209:etiology* / Q000523:psychology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008161:Lumbosacral Region / Q000503:physiopathology; D008297:Male; D051346:Mobility Limitation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000523:psychology; D011788:Quality of Life; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery*; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult