{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T21:37:43Z","timestamp":1792705063674,"version":"4.5.0"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 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\u2019s 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      When 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) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 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\u00b0) than in the non-DA group (1.3\u00b0) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 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\u201313.18) and the vertebral rotation discrepancy (OR = 4.09, 95% CI: 1.98\u20138.43).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Greater 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261498680","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:32:04Z","timestamp":1792441924000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"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"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8162-9585","authenticated-orcid":false,"given":"Hong Jin","family":"Kim","sequence":"first","affiliation":[{"name":"Korea University Guro Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8720-5484","authenticated-orcid":false,"given":"Subin","family":"Lim","sequence":"additional","affiliation":[{"name":"Korea University Guro 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