title: Assessment of Lowest Instrumented Vertebra Tilt on Radiographic Measurements in Lenke "C" Modifier Curves Undergoing Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis.
abstract: Multicenter, retrospective cohort study.
  
  
  
  The purpose of this study is to determine how the amount of residual lowest instrumented vertebra (LIV) tilt correlates with radiographic measurements.
  
  
  
  When performing a selective thoracic posterior spinal fusion for adolescent idiopathic scoliosis (AIS), the LIV may be tilted into the lumbar curve or made horizontal.
  
  
  
  This is a multicenter retrospective study of 33 consecutive patients with AIS, Lenke types 1 to 4, lumbar modifier C, and a minimum follow-up of 2 years, who underwent selective thoracic posterior spinal fusions. Measurements obtained from pre- and postoperative radiographs were correlated with postoperative LIV tilt.
  
  
  
  At final follow-up, less postoperative LIV tilt significantly correlated with less thoracic apical translation (p = .023) when controlling for the position of the LIV relative to the stable vertebra and preoperative thoracic and lumbar curve flexibility. LIV tilt was not significantly associated with thoracic Cobb angle, lumbar Cobb angle, lumbar apical translation, coronal balance, sagittal balance, or the amount of correction obtained compared to their preoperative measurements (p > .05).
  
  
  
  Decreased LIV tilt was significantly associated with decreased thoracic apical translation. LIV tilt did not significantly correlate with coronal balance or any other radiographic measurement. We caution that these findings may only be applicable in C modifier curves and when the correct LIV is chosen.
  
  
  
  Level III, Therapeutic study.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA. Electronic address: dskaggs@chla.usc.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Seehausen
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
authors.forename: Kent T
authors.initials: KT
authors.lastname: Yamaguchi
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Hah
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Columbia University Medical Center, 630 West 168th St., New York, NY 10032, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Wright
authors.affiliation: Orthopaedic Surgery, Washington University School of Medicine, 550 S. Euclid Ave, St. Louis, MO 63110, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Bumpass
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St., New York, NY 10021, USA.
authors.forename: Han J
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Andras
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Columbia University Medical Center, 630 West 168th St., New York, NY 10032, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
authors.affiliation: Orthopaedic Surgery, Washington University School of Medicine, 550 S. Euclid Ave, St. Louis, MO 63110, USA.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
mesh_terms: D000293:Adolescent; D006801:Humans; D008159:Lumbar Vertebrae; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
keywords: Adolescent idiopathic scoliosis; Cobb angle; Decompensation; Lowest instrumented vertebra; Selective thoracic posterior spinal fusion