Evidence map›Paper›PMID 42400631›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Evaluating differences in the upper instrumented vertebra (UIV) tilt angle between adolescent idiopathic scoliosis patients with Lenke 1-ve (flexible) and Lenke 1 +ve (stiff) curves.

Sin Ying Lee, Ingrid Frances Dizon Ignacio, Van Jet Leong, Nur Farah Anis Abd Halim, Saturveithan Chandirasegaran, Chee Kidd Chiu, Chris Yin Wei Chan, Mun Keong Kwan

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Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Sin Ying LeeMalayaDepartment of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Ingrid Frances Dizon IgnacioMalayaDepartment of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Van Jet LeongMalayaDepartment of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Nur Farah Anis Abd HalimMalayaDepartment of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Saturveithan ChandirasegaranMalayaDepartment of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Chee Kidd ChiuMalayaDepartment of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Chris Yin Wei ChanMalayaDepartment of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Mun Keong KwanMalayaDepartment of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. munkeong42@hotmail.com.ORCID https://orcid.org/0000-0002-9512-3155

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo analyse the mean optimal upper instrumented vertebra (UIV) tilt angle in Lenke 1 subgroups with UIV at T2, T3, and T4, as derived from preoperative supervised cervical supine side-bending radiographs.

methodsThis retrospective study included 288 Lenke 1 adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion between 2020 and 2023, with UIV selected at T2, T3, or T4 levels. All patients were categorised into two subgroups: Lenke 1-ve (flexible) (proximal thoracic side bending (PTSB) Cobb angle: <15°) and Lenke 1 + ve (stiff) (PTSB Cobb angle: 15°-24.9°). Primary radiological parameters analysed included optimal UIV tilt angle (derived from preoperative supervised cervical supine side-bending radiographs), intraoperative UIV tilt angle, proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TL/L) Cobb angles, T1 tilt, clavicle angle (Cla-A), cervical axis (CA), and coronal balance (CB).

resultsThe optimal UIV tilt angle demonstrated excellent inter-rater and intra-rater reliability (ICC:0.890; 0.863). Lenke 1-ve and 1 + ve groups demonstrated different UIV level distributions (p < 0.001). In Lenke 1-ve group, the UIV levels were primarily at T3 (74.4%), followed by T4 (16.5%), and T2 (9.0%). Meanwhile, Lenke 1 + ve group had UIV at T3 (54.8%), followed by T2 (41.9%), and T4 (3.2%). The mean optimal UIV tilt differed significantly at T2, T3, and T4 for Lenke 1-ve group (-2.9°±3.9°, -5.2°±2.8°, -5.4°±1.5°) and Lenke 1 + ve group (-3.3°±2.7°; -5.4°±2.9°, -7.4°±5.2°) (p < 0.05). UIV level, apical vertebra level, and preoperative MT Cobb angle were significant predictive factors for optimal UIV tilt angle (p < 0.05). Patients with a negative preoperative T1 tilt had a more distal UIV level selected.

conclusionLenke 1 + ve (stiff) group had a more proximal UIV level selected than Lenke 1-ve (flexible) group. Notably, UIV levels at T2, T3, and T4 demonstrated significantly different mean optimal UIV tilt angles, with more negative tilt magnitudes as the selection progressed caudally.

Indexed as

Adolescent idiopathic scoliosisLenke 1Optimal UIV tilt angleUIV levelUpper instrumented vertebra

Identifiers

PMID42400631

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.