title: Risk Factors for Coronal Decompensation After Posterior Spinal Instrumentation and Fusion in Adolescent Idiopathic Scoliosis.
abstract: METHODS
  Retrospective review of multicenter data set with adolescent idiopathic scoliosis (AIS) patients with at least 2 years of follow-up after posterior spinal instrumentation and fusion (PSIF).
  
  
  OBJECTIVE
  The purpose of this study is to investigate risk factors for coronal decompensation 2 years after PSIF for AIS.
  
  
  BACKGROUND
  Coronal decompensation is a potential complication of spinal instrumentation for AIS. This can result in problems requiring revision surgery.
  
  
  METHODS
  Demographic, clinical, and radiographic measures were reviewed on 890 identified patients. Coronal decompensation was defined as a change farther away from midline from 6 weeks postoperatively to 2 years in any one of the following radiographic parameters: change in coronal balance >2 cm; change in coronal position of the lowest instrumented vertebra (LIV) >2 cm; change in thoracic trunk shift >2 cm; or change in LIV tilt angle >10°. Patients with decompensation were compared to those without. The relationship between the LIV and lowest end vertebra (LEV) was examined as an independent variable.
  
  
  RESULTS
  Two years postoperation, 6.4% (57/890) of patients exhibited coronal decompensation. Multivariate regression revealed that decompensated patients were twice as likely to be male, have lower preoperative Risser score, and lower percentage major curve correction. The relationship between the LIV and LEV as well as quality of life surveys were not significantly different between decompensated and nondecompensated patients at 2 years.
  
  
  CONCLUSIONS
  Two years after PSIF, 6.4% of patients with AIS exhibit radiographic coronal decompensation. Although this study did not demonstrate a significant association between the relationship of LIV and LEV and decompensation 2 years postoperation, results of this study indicate that skeletal immaturity, male gender, and less correction of the major curve may be related to higher rates of coronal decompensation.
authors.affiliation: Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Gomez
authors.affiliation: Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY 10032, USA. Electronic address: hm2174@columbia.edu.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Matsumoto
authors.affiliation: Department of Orthopedics, Tufts Medical Center, Boston, MA 02111, USA.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Colacchio
authors.affiliation: Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY 10032, USA; Division of Pediatric Orthopedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Roye
authors.affiliation: Department of Pediatric Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sucato
authors.affiliation: Department of Pediatric Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA.
authors.forename: B Stephens
authors.initials: BS
authors.lastname: Richards
authors.affiliation: Department of Orthopedic Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Emans
authors.affiliation: Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, CO 80045, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Erickson
authors.affiliation: Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Sanders
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.affiliation: Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY 10032, USA; Division of Pediatric Orthopedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
keywords: Adolescent idiopathic scoliosis; Coronal balance; Decompensation; Posterior spinal instrumentation and fusion