• Lei Zang, Yong Hai, Shuo Yuan, Qingjun Su, Jincai Yang, Li Guan, Nan Kang, Xianglong Meng, Yuzeng Liu, and Ning Fan.
• Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University.
• Spine. 2016 May 11.

Study DesignA retrospective study.ObjectiveTo identify associated risk factors of distal adding-on in severe and rigid scoliosis.Summary Of Background DataPrevious work has evaluated the challenges in the treatment of patients with severe and rigid scoliosis and the risks of complications. Furthermore, although several studies have investigated postoperative distal adding-on and attendant risk factors in Lenke type 1A scoliosis, very few have focused on distal adding-on in severe and rigid scoliosis.MethodsIn this study, 48 consecutive patients with severe and rigid scoliosis underwent posterior spinal fusion surgery. The parameters of preoperative, immediately postoperative, and minimum 2-year follow-up radiographs were evaluated. The patients were classified as positive or negative for distal adding-on at follow-up, and risk factors were comparatively analyzed in the two groups.ResultsThe average Cobb angle and flexibility of the main thoracic curve (MTC) were 107.4° ± 15.9° and 16.4% ± 10.2% before surgery. Distal adding-on was observed in 12 patients (25.0%) at follow-up. Univariate analysis identified several factors significantly associated with distal adding-on. Furthermore, significant independent risk factors identified by stepwise logistic regression analysis included the correction rate of the MTC immediately after surgery (odds ratio: 1.107, 95% confidence interval: 1.024-1.197, P = 0.011) and the difference between the LIV and LTV levels (odds ratio: 0.121, 95% confidence interval: 0.028-0.518, P = 0.004).ConclusionIn severe and rigid scoliosis, a high correction rate of the MTC immediately after surgery and the LIV level above the LTV were significantly associated with distal adding-on.Level Of Evidence3.

16 keywords...

hide…