Peer-reviewedCC BY-NC-NDGlobal spine journal19 Oct 2026

Vertebral Rotation Discrepancy for Distal Add-on when Selecting the Touched Vertebra as the Lowest Instrumented Vertebra in Thoracic Curves of Adolescent Idiopathic Scoliosis.

Hong Jin Kim¹
Subin Lim¹
Hyung Rae Lee²
Jae Hyuk Yang²
Seung Woo Suh¹

¹Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea.
²Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Republic of Korea.

Abstract

Study DesignRetrospective cohort study.ObjectivesTo assess the influencing factors of the distal add-on when selecting the touched vertebra (TV) as the lowest instrumented vertebra (LIV) in thoracic idiopathic scoliosis (IS).MethodsA total of 96 thoracic IS patients who underwent deformity correction with LIV = TV were retrospectively analyzed to evaluate the distal add-on. Patients were divided into the DA group and the non-DA group. Radiological variables included coronal (Cobb's angle, coronal balance, sacral slanting angle, and L4 vertebral tilt), sagittal (sagittal vertical axis, thoracic kyphosis, and lumbar lordosis), and axial parameters (vertebral rotation angle).ResultsWhen selecting the TV as the LIV, the occurrence rate of distal add-on was 20.8% (20 of 96) at a mean follow-up of 3 years. The mean number of remnant motion segments was significantly higher in the DA group (4.7) compared to the non-DA group (3.8) (P < 0.001). The difference in the vertebral rotation angle between the lumbar apex and the TV level was significantly higher in the DA group (6.6°) than in the non-DA group (1.3°) (P < 0.001). Multivariate logistic regression analysis demonstrated that the distal add-on was significantly associated with remnant motion segments (OR = 3.69, 95% CI: 1.03-13.18) and the vertebral rotation discrepancy (OR = 4.09, 95% CI: 1.98-8.43).ConclusionsGreater vertebral rotation discrepancy between the LIV and lumbar apex was consistently associated with distal add-on when the TV was selected as the LIV, suggesting that three-dimensional rotational mismatch may contribute to residual distal add-on risk.

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BibTeX RIS

BibTeX

@article{kim2026vertebral,
  title = {{Vertebral Rotation Discrepancy for Distal Add-on when Selecting the Touched Vertebra as the Lowest Instrumented Vertebra in Thoracic Curves of Adolescent Idiopathic Scoliosis.}},
  author = {Hong Jin Kim and Subin Lim and Hyung Rae Lee and Jae Hyuk Yang and Seung Woo Suh},
  journal = {Global spine journal},
  year = {2026},
  month = oct,
  doi = {10.1177/21925682261498680},
  url = {https://europepmc.org/article/MED/42896163},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Vertebral Rotation Discrepancy for Distal Add-on when Selecting the Touched Vertebra as the Lowest Instrumented Vertebra in Thoracic Curves of Adolescent Idiopathic Scoliosis.
AU  - Hong Jin Kim
AU  - Subin Lim
AU  - Hyung Rae Lee
AU  - Jae Hyuk Yang
AU  - Seung Woo Suh
PY  - 2026
DA  - 2026/10/19
JO  - Global spine journal
DO  - 10.1177/21925682261498680
UR  - https://europepmc.org/article/MED/42896163
AB  - Study DesignRetrospective cohort study.ObjectivesTo assess the influencing factors of the distal add-on when selecting the touched vertebra (TV) as the lowest instrumented vertebra (LIV) in thoracic idiopathic scoliosis (IS).MethodsA total of 96 thoracic IS patients who underwent deformity correction with LIV = TV were retrospectively analyzed to evaluate the distal add-on. Patients were divided into the DA group and the non-DA group. Radiological variables included coronal (Cobb's angle, coronal balance, sacral slanting angle, and L4 vertebral tilt), sagittal (sagittal vertical axis, thoracic kyphosis, and lumbar lordosis), and axial parameters (vertebral rotation angle).ResultsWhen selecting the TV as the LIV, the occurrence rate of distal add-on was 20.8% (20 of 96) at a mean follow-up of 3 years. The mean number of remnant motion segments was significantly higher in the DA group (4.7) compared to the non-DA group (3.8) (P < 0.001). The difference in the vertebral rotation angle between the lumbar apex and the TV level was significantly higher in the DA group (6.6°) than in the non-DA group (1.3°) (P < 0.001). Multivariate logistic regression analysis demonstrated that the distal add-on was significantly associated with remnant motion segments (OR = 3.69, 95% CI: 1.03-13.18) and the vertebral rotation discrepancy (OR = 4.09, 95% CI: 1.98-8.43).ConclusionsGreater vertebral rotation discrepancy between the LIV and lumbar apex was consistently associated with distal add-on when the TV was selected as the LIV, suggesting that three-dimensional rotational mismatch may contribute to residual distal add-on risk.
SN  - 2192-5682
SN  - 2192-5690
ER  -

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