ArticleOrthopaedic surgery2025
Is It Enough to Stop Distal Fusion at L3 in Mild to Moderate Lenke 5C Adolescent Idiopathic Scoliosis Patients?
Article in Orthopaedic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Utilization of posterior column osteotomies with posterior spinal fusion for correction of Lenke type 5 adolescent idiopathic scoliosis: a systematic review.Spine deformity · 2026Article
- Distal Adding-On After Selective Thoracolumbar/Lumbar Fusion for Lenke 5C AIS: The Role of Proximal Coronal Construct Position and Postoperative UIV Translation.Orthopaedic surgery · 2026Article
- Advances in fusion level selection and surgical approaches for adolescent idiopathic scoliosis based on the Lenke classification system: a narrative review.BMC surgery · 2026Review
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Abstract
objectiveThere has been no definitive conclusion on the selection of the lowest instrumented vertebra (LIV) in Lenke 5C adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to evaluate whether it is enough to stop distal fusion at L3 in mild to moderate Lenke 5C AIS patients with posterior selective lumbar fusion, Ponte osteotomies and segmental direct vertebra rotation and to analyze the risk factors for postoperative complications in patients selecting L3 as the LIV.
methodsA retrospective review was conducted on 106 Lenke 5C AIS patients who underwent corrective surgery in our institution from 2010 to 2021, with a minimum 2-year follow-up. The LIV was L3 or L4. According to the LIV, patients were initially divided into Group I (the LIV was L3) and Group II (the LIV was L4). Then, Group I was further divided into a complication group and a non-complication group. Demographics, radiological parameters, postoperative complications, and clinical outcomes were recorded. Univariate analysis and multivariate logistic analysis were used to identify the risk factors for postoperative complications in patients with L3 as the LIV.
resultsThere were no significant differences in the demographics, radiological parameters, postoperative complications, or clinical outcomes between Group I and Group II (p > 0.05), and the outcomes were satisfactory in both groups. The main postoperative complications were distal adding-on (11 cases), coronal imbalance (16 cases), proximal junctional kyphosis (2 cases), and internal fixation failure (4 cases). Logistic regression analysis revealed that age and postoperative C7-CSVL were independent predictors of postoperative complications when selecting L3 as the LIV.
conclusionTerminating the distal fusion level at L3 was practical for mild to moderate Lenke 5C AIS patients. For patients selecting L3 as the LIV, younger patients should be cautious, and maintaining postoperative coronal balance is necessary for avoiding postoperative complications.
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