• Dong-Gune Chang, Lawrence G Lenke, Hong Jin Kim, Javier Pizones, René Castelein, Per D Trobisch, Kota Watanabe, Kee-Yong Ha, and Se-Il Suk.
• Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, 1342, Dongil-Ro, Nowon-Gu, Seoul, 01757, Republic of Korea.
• Eur Spine J. 2024 Dec 5.

PurposeTo assess the benefits of using the touched vertebra (TV) rule in Lenke classification for thoracic curves of adolescent idiopathic scoliosis (AIS).MethodsA total of 141 AIS patients with thoracic curves determined by Suk classification were divided based on whether the lowest instrumented vertebra (LIV) matched the TV into groups of mTV (n = 84, LIV = TV), TV- (n = 21, LIV above TV), and TV+ (n = 36, LIV below TV) for 5-year follow-up. The radiological parameters were the central sacral vertical line (CSVL)-LIV distance, distal end vertebra rotation, coronal, and sagittal parameters. Complications included adding-on phenomenon, coronal imbalance, and distal junctional kyphosis.ResultsAdding-on phenomenon and coronal imbalance were significantly higher in the TV- group (P = 0.006) and TV + group (P = 0.006), respectively. The distal motion segments were significantly saved in the mTV group (P < 0.001). The CSVL-LIV distance was significantly improved in the mTV group compared to the others during the 5-year follow-up (P = 0.007). The 5-year follow-up CSVL-LIV distance correlated with LIV tilt angle (r = 0.442, P = 0.021) and coronal balance (r = 0.437, P = 0.023).ConclusionsSelecting the TV as LIV minimizes the loss of the distal mobile segment and reduces the complications in the thoracic curves of AIS, which produces a more stable LIV on the CSVL. Therefore, TV is an ideal landmark for determining the distal fusion level using the Lenke classification or Suk classification.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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