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Purpose <p>To 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.</p> Methods <p>This 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 <i>(flexible)</i> (proximal thoracic side bending (PTSB) Cobb angle: &lt;15°) and Lenke 1 + ve <i>(stiff)</i> (PTSB Cobb angle: 15°–24.9°). Primary radiological parameters analysed included optimal UIV tilt angle (<i>derived from preoperative supervised cervical supine side-bending radiographs</i>), 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).</p> Results <p>The 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 (<i>p</i> &lt; 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°) (<i>p</i> &lt; 0.05). UIV level, apical vertebra level, and preoperative MT Cobb angle were significant predictive factors for optimal UIV tilt angle (<i>p</i> &lt; 0.05). Patients with a negative preoperative T1 tilt had a more distal UIV level selected.</p> Conclusion <p>Lenke 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.</p>

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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

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • 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

摘要

Purpose

To 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.

Methods

This 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).

Results

The 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.

Conclusion

Lenke 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.