title: Postoperative distal adding-on and related factors in Lenke type 1A curve.
abstract: METHODS
  A retrospective, multicenter study.
  
  
  OBJECTIVE
  To investigate the occurrence of and factors related to postoperative adding-on in Lenke type 1A curve.
  
  
  BACKGROUND
  Although several studies have investigated factors associated with adding-on in Lenke type 1A curve, these factors have not been elucidated in a large study population.
  
  
  METHODS
  This study included 112 patients who were followed more than 2 years after undergoing selective posterior thoracic fusion surgery for Lenke Type 1A curve (8 males, 104 females; mean age at surgery, 16.1 yr; mean follow-up, 3.6 yr). The lower instrumented vertebra (LIV) was T12 in 22 patients, L1 in 55, L2 in 32, and L3 in 3. Distal to the main thoracic curve, the end vertebra, neutral vertebra, stable vertebra (SV), and the last vertebra touching the central sacral vertical line (last touching vertebra, LTV) were determined. The occurrence and factors associated with distal adding-on were investigated.
  
  
  RESULTS
  The mean Cobb angle and apical translation of the main thoracic curve were 54.6° ± 9.6° and 53.1 ± 20.4 mm before surgery, and 14.2 ± 7.4 and 16.2 ± 12.7 at follow-up, respectively. Distal adding-on was observed in 21 patients (18.8%) at follow-up. Univariate analyses identified several factors significantly associated with adding-on, including the preoperative proximal thoracic curve, the apical translation of the main thoracic curve, Miyanji's subclassification, the postsurgical proximal and main thoracic curves, the postsurgical apical translation of the main thoracic curve, the correction rate of the main thoracic curve and the clavicle angle immediately after surgery and at follow-up, and the difference in levels between the LIV and the end vertebra, neutral vertebra, LTV, and stable vertebra. Logistic regression analysis showed that the apical translation of the main thoracic curve immediately after surgery (apical translation >25 mm, odds ratio: 10.7, 95% confidence interval: 3.1-37.0, P = 0.001) and the difference in levels between LIV and LTV (LIV-LTV) (LIV-LTV <0, odds ratio: 6.7, 95% confidence interval: 1.9-23.9, P = 0.003) were significantly associated with adding-on.
  
  
  CONCLUSIONS
  Since the residual apical translation of the main thoracic curve and the lowest instrumented vertebra more cranial to the last touching vertebra were significantly associated with adding-on, surgeons may need to obtain the maximum reduction of the apical translation of the main thoracic curve and to extend the LIV at least to the LTV to avoid postoperative adding-on.
authors.affiliation: *Department of Orthopaedic Surgery, Keio University, Tokyo, Japan †Department of Orthopaedic Surgery, Meijo Hospital, Nagoya Japan ‡Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Hyogo, Japan §Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan ¶Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Fukuoka, Japan; and ‖Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.forename: Naobumi
authors.initials: N
authors.lastname: Hosogane
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kawakami
authors.forename: Taichi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Koki
authors.initials: K
authors.lastname: Uno
authors.forename: Teppei
authors.initials: T
authors.lastname: Suzuki
authors.forename: Manabu
authors.initials: M
authors.lastname: Ito
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Yanagida
authors.forename: Toru
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Shohei
authors.initials: S
authors.lastname: Minami
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Akazawa
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000639:trends; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult