• Masaya Mizutani, Toshiaki Kotani, Yasuchika Aoki, Shuhei Iwata, Shun Okuwaki, Shuhei Ohyama, Kotaro Sakashita, Yosuke Ogata, Yasushi Iijima, Tsuyoshi Sakuma, Sumihisa Orita, Kazuhide Inage, Yasuhiro Shiga, Shohei Minami, and Seiji Ohtori.
• Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan; Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: anchan7117@gmail.com.
• World Neurosurg. 2024 Nov 29; 194: 123404123404.

BackgroundPatients with residual adolescent idiopathic scoliosis (AIS) and thoracolumbar/lumbar curves may present with progression after cessation of growth, with lateral translation as a major risk factor. Nonetheless, radiographic predictors and underlying mechanisms remain indefinite. This study aimed to determine these radiographic predictors and structural mechanisms in patients with residual AIS.MethodsRadiographic and clinical data were collected from 45 consecutive patients with preoperative residual AIS and thoracolumbar/lumbar Cobb angle >40° who subsequently underwent corrective surgery at our institution. Lateral translation was defined as intervertebral slippage ≥6 mm on computed tomography. Statistical analyses included Student's t-test, Pearson's correlation coefficients, receiver operating characteristic curve analysis, and multivariate logistic regression analysis.ResultsOf 45 patients, 3 were male, whereas 42 were female, with a mean age of 40.6 ± 17.4 years. L3 slippage was observed in 21 patients, resulting in the categorization into the slippage and nonslippage cohorts. Multivariate logistic regression analysis revealed statistically significant disparities in the bilateral facet angles, facet joint opening, and facet joint vacuum phenomenon between the 2 cohorts. The receiver operating characteristic analysis determined a 20.5° cut-off value for predicting L3 slippage. In the nonslippage cohort, a strong correlation was particularly observed between L3 slippage and L2-L3 bridging.ConclusionsFacet joint instability, L4 tilt ≥20.5°, and L3 cranial vertebral bridging are predictive radiographic factors for L3 lateral translation in patients with residual AIS. Thus, patients exhibiting these characteristics require consistent follow-up or early surgical intervention before lateral translation occurs.Copyright © 2024 Elsevier Inc. All rights reserved.

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