• Dong-Gune Chang, Jae Hyuk Yang, Se-Il Suk, Seung-Woo Suh, Young-Hoon Kim, Woojin Cho, Yeon-Seok Jeong, Jin-Hyok Kim, Kee-Yong Ha, and Jung-Hee Lee.
• *Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, The Inje University, Seoul, Korea †Department of Orthopaedic Surgery, Korea University Guro-Hospital, College of Medicine, The Korea University, Seoul, Korea ‡Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea §Department of Orthopaedic Surgery, The University Hospital for Albert Einstein, Albert Einstein College of Medicine, New York, United States ¶Department of Orthopaedic Surgery, Kyung Hee Hospital, College of Medicine, The Kyung Hee University, Seoul, Korea.
• Spine. 2016 Nov 22.

Study DesignA retrospective comparative study.ObjectiveTo analyze the exact distal fusion level in the treatment of major thoracolumbar and lumbar (TL/L) adolescent idiopathic scoliosis (AIS) using rod derotation (RD) and direct vertebral rotation (DVR) following pedicle screw instrumentation (PSI).Summary Of Background DataProper determination of distal fusion level is a very important factor in deformity correction and preservation of motion segments in the treatment of major TL/L AIS.MethodsAIS patients with major TL/L curves (n = 64) treated by PSI with RD and DVR methods with a minimum 2-year follow-up were divided into AL3 (flexible) and BL3 (rigid) according to the flexibility and rotation by preoperative bending radiographs.ResultsThere was no significant difference in TL/L (major) curve between the AL3 and BL3 groups postoperatively (P = 0.933) and at the last follow-up (P = 0.144). Additionally, there was no significant difference in thoracic (minor) and compensatory (caudal) curve postoperatively (thoracic curve: P = 0.828, compensatory curve: P = 0.976); however, there was a significant difference in compensatory (caudal) curve at the last follow-up (P = 0.041). The overall prevalence of unsatisfactory results was 28.1% (18/64 patients), and the prevalence was 15.2% (7/46) in the AL3 group and 61.1% (11/18) in the BL3 group, which was significantly different (P < 0.05).ConclusionsLIV would be selected at L3 (EV) when the curve is flexible; L3 crosses CSVL with a rotation of less than grade II in preoperative bending radiographs. However, if the curve is rigid, LIV should be extended to L4 (EV + 1) in order to prevent the adding-on phenomenon in the treatment of major TL/L AIS using RD and DVR following PSI.Level Of Evidence4.

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