Relationship between lumbosacral transitional vertebra and postoperative outcomes of patients with Lenke 5C adolescent idiopathic scoliosis: a minimum 5-year follow-up study.

Abstract

To assess the incidence of lumbosacral transitional vertebra (LSTV) in Lenke 5C adolescent idiopathic scoliosis (AIS) and evaluate the relationship between postoperative outcomes and LSTV when the lowest instrumented vertebra (LIV) is fixed at L3. The study included 61 patients with Lenke 5C AIS who underwent fusion surgery of L3 as the LIV who were followed-up for a minimum of 5 years. Patients were divided into two groups: LSTV + and LSTV-. Demographic, surgical, and radiographic data, including L4 tilt and thoracolumbar/lumbar (TL/L) Cobb angle, were obtained and analyzed. LSTV was observed in 15 patients (24.5%). The L4 tilt was not significantly different between the two groups preoperatively (P = 0.54); however, it was significantly greater in the LSTV group postoperatively (2 weeks: LSTV +  = 11.7 ± 3.1, LSTV -  = 8.8 ± 3.2, P = 0.013; 2 years: LSTV +  = 11.5 ± 3.5, LSTV -  = 7.9 ± 4.1, P = 0.006; 5 years: LSTV +  = 9.8 ± 3.1, LSTV -  = 7.3 ± 4.5,  P= 0.042). The postoperative TL/L curve was greater in the LSTV + group, with significant differences at 2 weeks and 2 years postoperatively (preoperative: LSTV +  = 53.5 ± 11.2, LSTV -  = 51.7 ± 10.3,P = 0.675; 2 weeks: LSTV +  = 16.1 ± 5.0, LSTV- = 12.2 ± 6.6, P = 0.027; 2 years: LSTV +  = 21.7 ± 5.9, LSTV -  = 17.6 ± 5.9, P = 0.035; 5 years: LSTV +  = 18.7 ± 5.8, LSTV -  = 17.0 ± 6.1, P = 0.205). The prevalence of LSTV in Lenke 5C AIS patients was 24.5%. Lenke 5C AIS patients with LSTV with the LIV at L3 had a significantly greater postoperative L4 tilt than those without LSTV and retained the TL/L curve.