Document Detail

Postoperative Segmental Motion of the Unfused Spine Distal to the Fusion in 100 Adolescent Idiopathic Scoliosis Patients.
MedLine Citation:
PMID:  22024909     Owner:  NLM     Status:  Publisher    
ABSTRACT: Study Design. A cross sectional study.Objective. The purpose of this study was to assess inter-vertebral segmental and cumulative motion in the distal un-fused segments of the spine in patients with Adolescent Idiopathic Scoliosis (AIS) following instrumentation as a function of the lowest instrumented level.Summary of Background Data. The implications of hyper or hypo-mobility in the un-fused segments of the spine following instrumentation are poorly understood. There is a paucity of research on changes in functional movement capabilities of the spine following thoracolumbar spinal fusion.Methods. Patients were prospectively offered inclusion into this IRB approved cross-sectional study at their routine 2, 3, 4 or 5 year post-operative visit at one of 5 participating centers. Motion was assessed by standardized radiographs acquired in maximum right, left and forwarding bending positions. The intervertebral angles were measured via digital radiographic measuring software at each level from T12 to S1. The relationship of the vertebral segmental motion for each interspace to the lowest instrumented vertebrae was evaluated with an ANOVA. The relationship between the cumulative preserved motion and each domain of the Scoliosis Research Society (SRS) questionnaire were evaluated using a Pearson's correlation coefficient.Results: The data for 100 patients are included. The lowest instrumented vertebrae ranged from T10 to L4. In lateral bending, an association was detected between the lowest fused vertebral level and the degree of motion at the distal unfused segments. With a more distal instrumented vertebrae, there was significantly greater L2/L3, L3/L4, and L4/L5 segment motion (p = 0.002, 0.009 and 0.001 respectively). A similar trend was appreciated at L5-S1 level. In addition, the summed motion from L3 to S1 also increased with a more distal fusion (p = 0.001). Similar results were not found in forward bending. None of the domains of the SRS questionnaire correlated with the preserved L3-S1 motion.Conclusion: In a group of post-operative adolescent idiopathic scoliosis patients, evaluation of the distal unfused intervertebral motion showed that preservation of vertebral motion segments allowed greater distribution of functional motion across more levels. With each distal fusion level, motion was significantly increased at the L2/L3, L3/L4, and L4/L5 segmental levels in lateral bending. The relationship between the increased motion and subsequent disc degeneration with a more distal fusion is unknown, but suspected.
Michelle Marks; Peter O Newton; Maty Petcharaporn; Tracey P Bastrom; Suken Shah; Randal Betz; Baron Lonner; Firoz Miyanji
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-21
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Orthopedics, Rady Children's Hospital - San Diego, CA 2Department of Orthopedic Surgery, University of California San Diego 3Department of Orthopedics, Nemours Children's Clinic, Wilmington, DE 4Department of Orthopedics, Shriners Hospital for Children, Philadelphia, PA 5Scoliosis Associates, New York, NY 6Department of Orthopedics, BC Childrens Hospital, Vancouver, BC.
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