Selecting the LSTV as the Lower Instrumented Vertebra in the Treatment of Lenke Types 1A and 2A Adolescent Idiopathic Scoliosis: A Minimal 3-year Follow-up

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Study Design.

Retrospective study.


The purpose of this study was to verify the last substantially touched vertebra (LSTV) as the ideal lower instrumented vertebra (LIV) and to identify predictive factors of adding-on in patients with Lenke type 1A and 2A curve patterns when LSTV was chosen as the LIV.

Summary of Background Data.

Although several studies have indicated that the use of the LSTV as the LIV can obtain favorable outcomes in Lenke 1A and 2A curves, the factors identifying patients with Lenke 1A and 2A curve patterns who should undergo a fusion extending beyond the LSTV have not been identified.


A total of 120 patients with Lenke 1 and 2 curves after posterior instrumentation and fusion to the LSTV were evaluated. All patients had a minimum 3-year follow-up. Patients were grouped based on the occurrence of the distal adding-on phenomenon: an adding-on group and a no adding-on group. We analyzed the significant independent factors associated with adding-on via univariate analysis and then via stepwise logistic regression analysis.


Distal adding-on was observed in 16 patients (13.33%). Binary logistic regression analysis showed that the Risser sign (OR = 0.592, P = 0.033), preoperative distance between the LIV and the center sacral vertical line (CSVL) (LIV-CSVL) (OR = 1.286, P = 0.002), and postoperative thoracic kyphosis (T5–T12) (OR = 0.784, P = 0.002) were primary factors for distal adding-on.


Selecting the LSTV as the LIV simplifies the selection of the LIV and is an effective operation strategy in patients with Lenke 1A and 2A curve types. Patients with lower Risser sign, larger preoperative LIV-CSVL, and postoperative thoracic hypokyphosis are more likely to develop distal adding-on at 3-year follow-up.


Level of Evidence: 4

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