CORR Insights^®: Preventing Fusion Mass Shift Avoids Postoperative Distal Curve Adding-on in Adolescent Idiopathic Scoliosis

Excerpt

When a scoliotic curve extends into the lumbar spine, the surgeon is faced with a natural desire to straighten the entire curve, permanently and completely. However, numerous authors [3‐5] have shown that preservation of motion segments is important for long-term painless function, particularly in the low lumbar spine. Complicating the decision-making process is the phenomenon of adding-on, in which segments that may appear to be uninvolved in the curve become part of the lumbar curve after surgery. In the current study, Shigematsu and colleagues outline one factor, fusion mass shift, which appears related to the phenomenon of adding-on. Moreover, this factor is controllable by the surgeon, both in preoperative surgery level selection and in the conduct of surgery intraoperatively. As such, fusion mass shift has the potential to improve patient results by minimizing the risk of postoperative adding-on. …