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Abstract：
OBJECTIVE: It is important to protect the mobile segment in the lumbar region in scoliosis surgery. The aim of this study was to compare the clinical and radiological results of patients who underwent surgery for a diagnosis of adolescent idiopathic scoliosis (AIS) with the lowest instrumented vertebra (LIV) at L3 or L4 level.
METHODS: The study included 36 patients who underwent surgical treatment in our institution for a diagnosis of Lenke type 5 and 6 AIS with a follow-up period of at least 24 months. The patients were separated into 2 groups according to the LIV level of L3 (n=21) and L4 (n=15). These 2 groups were compared preoperatively (PO), early postoperative (EPO), and at the final follow-up examination (last control (LC)) with respect to radiological parameters in the coronal and sagittal planes, and the Scoliosis Research Society - 22 (SRS-22) questionnaire values.
RESULTS: In both groups the mean age (L3: 16 ± 7.3; L4: 17 ± 6.1 years) and follow-up periods (L3: 44 ± 20; L4: 47 ± 18 months) were similar. Radiologically, the L4 group had a greater Cobb angle in the scoliosis main curves measured PO (P=.001). The Cobb angles measured at EPO (P=.767) and at LC (P=.674) were similar in both groups. No significant difference was observed between the 2 groups in respect of the LIV tilt values at PO (P=.469), EPO (P=.297), and LC (P=.065). When the groups were evaluated separately, the LIV tilt values at EPO and LC were similar in the L4 group (EPO: 6.93 ± 3.058; LC: 7.26 ± 2.313; P=.618). In the L3 patients, although there seemed to be a significant increase in LIV tilt values when EPO values were compared with LC values (EPO: 8.47 ± 3.970; LC: 9.57 ± 3.76; P=.030), this was within the error range of Cobb angle measurement. The results of the SRS-22 questionnaire showed significantly better results in the L3 group in the domains of pain, function/activity, mental health, and satisfaction with treatment (P=.011, P=.002, P=.019, P=.046, respectively).
CONCLUSIONS: There was no radiological superiority between L3 and L4 LIV groups in the thoracolumbar/lumbar curve patients. However, according to the SRS-22 questionnaire, the results of patients with L3 level LIV were better in the areas of pain, function/activity, mental health, and satisfaction with treatment. Cite this article as: Baymurat AC, Tokgoz MA, Abdulaliyev F, Tosun MF, Can MM, Senkoylu A. Which lumbar vertebra should be the lowest level of fusion in adolescent idiopathic scoliosis of Lenke types 5 and 6? Acta Orthop Traumatol Turc., 2024;58(2):116-123.
METHODS: The study included 36 patients who underwent surgical treatment in our institution for a diagnosis of Lenke type 5 and 6 AIS with a follow-up period of at least 24 months. The patients were separated into 2 groups according to the LIV level of L3 (n=21) and L4 (n=15). These 2 groups were compared preoperatively (PO), early postoperative (EPO), and at the final follow-up examination (last control (LC)) with respect to radiological parameters in the coronal and sagittal planes, and the Scoliosis Research Society - 22 (SRS-22) questionnaire values.
RESULTS: In both groups the mean age (L3: 16 ± 7.3; L4: 17 ± 6.1 years) and follow-up periods (L3: 44 ± 20; L4: 47 ± 18 months) were similar. Radiologically, the L4 group had a greater Cobb angle in the scoliosis main curves measured PO (P=.001). The Cobb angles measured at EPO (P=.767) and at LC (P=.674) were similar in both groups. No significant difference was observed between the 2 groups in respect of the LIV tilt values at PO (P=.469), EPO (P=.297), and LC (P=.065). When the groups were evaluated separately, the LIV tilt values at EPO and LC were similar in the L4 group (EPO: 6.93 ± 3.058; LC: 7.26 ± 2.313; P=.618). In the L3 patients, although there seemed to be a significant increase in LIV tilt values when EPO values were compared with LC values (EPO: 8.47 ± 3.970; LC: 9.57 ± 3.76; P=.030), this was within the error range of Cobb angle measurement. The results of the SRS-22 questionnaire showed significantly better results in the L3 group in the domains of pain, function/activity, mental health, and satisfaction with treatment (P=.011, P=.002, P=.019, P=.046, respectively).
CONCLUSIONS: There was no radiological superiority between L3 and L4 LIV groups in the thoracolumbar/lumbar curve patients. However, according to the SRS-22 questionnaire, the results of patients with L3 level LIV were better in the areas of pain, function/activity, mental health, and satisfaction with treatment. Cite this article as: Baymurat AC, Tokgoz MA, Abdulaliyev F, Tosun MF, Can MM, Senkoylu A. Which lumbar vertebra should be the lowest level of fusion in adolescent idiopathic scoliosis of Lenke types 5 and 6? Acta Orthop Traumatol Turc., 2024;58(2):116-123.
摘要：
目的：在脊柱侧凸手术中保护腰椎区活动节段具有重要意义。这项研究的目的是比较接受手术诊断为L3或L4水平最低的器械椎骨（LIV）的青少年特发性脊柱侧凸（AIS）的患者的临床和放射学结果。
方法：该研究包括36例患者，这些患者在我们机构接受手术治疗，诊断为Lenke5型和6型AIS，随访期至少24个月。根据L3（n=21）和L4（n=15）的LIV水平将患者分为2组。两组术前(PO)比较,术后早期（EPO），在最后的随访检查（最后一次控制（LC））中，关于冠状面和矢状面的放射学参数，和脊柱侧弯研究学会-22（SRS-22）问卷值。
结果：两组的平均年龄（L3：16±7.3；L4：17±6.1岁）和随访时间（L3：44±20；L4：47±18个月）相似。放射学上,L4组在测量的脊柱侧凸主曲线中具有较大的Cobb角(P=.001)。两组在EPO（P=0.767）和LC（P=0.674）下测得的Cobb角相似。在PO时的LIV倾斜值方面，两组之间没有观察到显着差异（P=0.469），EPO（P=.297），和LC（P=.065）。当分别对各组进行评估时，L4组EPO和LC的LIV倾斜值相似(EPO:6.93±3.058;LC:7.26±2.313;P=.618).在L3患者中，尽管将EPO值与LC值进行比较时，LIV倾斜值似乎显着增加（EPO：8.47±3.970；LC：9.57±3.76；P=.030），这在Cobb角测量的误差范围内。SRS-22问卷的结果显示，L3组在疼痛领域的结果明显更好，功能/活动，心理健康,和对治疗的满意度（分别为P=.011，P=.002，P=.019，P=.046）。
结论：在胸腰椎/腰椎曲线患者中，L3和L4LIV组没有放射学优势。然而,根据SRS-22调查问卷，L3水平LIV的患者在疼痛方面的结果更好，功能/活动，心理健康,以及对治疗的满意度。引用这篇文章：BaymuratAC，TokgozMA,AbdulaliyevF,TosunMF,可以MM,SenkoyluA.Lenke5型和6型青少年特发性脊柱侧凸的融合水平最低的腰椎应该是哪一个？ActaOrthopTraumatolTurc。,2024；58（2）：116-123。
方法：该研究包括36例患者，这些患者在我们机构接受手术治疗，诊断为Lenke5型和6型AIS，随访期至少24个月。根据L3（n=21）和L4（n=15）的LIV水平将患者分为2组。两组术前(PO)比较,术后早期（EPO），在最后的随访检查（最后一次控制（LC））中，关于冠状面和矢状面的放射学参数，和脊柱侧弯研究学会-22（SRS-22）问卷值。
结果：两组的平均年龄（L3：16±7.3；L4：17±6.1岁）和随访时间（L3：44±20；L4：47±18个月）相似。放射学上,L4组在测量的脊柱侧凸主曲线中具有较大的Cobb角(P=.001)。两组在EPO（P=0.767）和LC（P=0.674）下测得的Cobb角相似。在PO时的LIV倾斜值方面，两组之间没有观察到显着差异（P=0.469），EPO（P=.297），和LC（P=.065）。当分别对各组进行评估时，L4组EPO和LC的LIV倾斜值相似(EPO:6.93±3.058;LC:7.26±2.313;P=.618).在L3患者中，尽管将EPO值与LC值进行比较时，LIV倾斜值似乎显着增加（EPO：8.47±3.970；LC：9.57±3.76；P=.030），这在Cobb角测量的误差范围内。SRS-22问卷的结果显示，L3组在疼痛领域的结果明显更好，功能/活动，心理健康,和对治疗的满意度（分别为P=.011，P=.002，P=.019，P=.046）。
结论：在胸腰椎/腰椎曲线患者中，L3和L4LIV组没有放射学优势。然而,根据SRS-22调查问卷，L3水平LIV的患者在疼痛方面的结果更好，功能/活动，心理健康,以及对治疗的满意度。引用这篇文章：BaymuratAC，TokgozMA,AbdulaliyevF,TosunMF,可以MM,SenkoyluA.Lenke5型和6型青少年特发性脊柱侧凸的融合水平最低的腰椎应该是哪一个？ActaOrthopTraumatolTurc。,2024；58（2）：116-123。
