{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T00:56:00Z","timestamp":1793235360441,"version":"4.5.0"},"reference-count":70,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spinal deformity, frequently requiring fusion surgery. An optimal fusion surgical strategy can not only achieve effective correction but also reduce the incidence of postoperative complications. Recently, several researchers have refined and expanded AIS fusion surgical strategies based on the Lenke classification system, which is the current international standard for AIS. Therefore, this study aims to review the advances in fusion level selection and surgical approaches for AIS based on this classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Databases such as PubMed, Embase, Web of Science, Scopus, Cochrane Database, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Literature Database were queried for articles using the keywords \u201cadolescent idiopathic scoliosis\u201d, \u201cfusion surgery\u201d, \u201cLenke classification system\u201d, \u201cLenke 1\u201d, \u201cLenke 2\u201d, \u201cLenke 3\u201d, \u201cLenke 4\u201d, \u201cLenke 5\u201d and \u201cLenke 6\u201d.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over the past decade, fusion surgical guidelines based on the Lenke classification have been refined, with new strategies emerging. We summarize the latest AIS fusion surgical strategies with recent research results. However, the fusion strategy based on the Lenke classification system has undergone no revolutionary changes. The selection of surgical designs for certain subtypes remains controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The fusion surgical strategy based on the Lenke classification system remains the standard for AIS surgical treatment. With the advancement of surgical technologies, further optimization of surgical strategies and the development of three-dimensional classification systems are potential future directions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12893-025-03481-9","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T16:00:18Z","timestamp":1767628818000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Advances in fusion level selection and surgical approaches for adolescent idiopathic scoliosis based on the Lenke classification system: a narrative review"],"prefix":"10.1186","volume":"26","author":[{"given":"Ruiyuan","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Xi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aobo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziqian","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minghui","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"issue":"2","key":"3481_CR1","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.nec.2007.02.006","volume":"18","author":"LG Lenke","year":"2007","unstructured":"Lenke LG. The Lenke classification system of operative adolescent idiopathic scoliosis. Neurosurg Clin N Am. 2007;18(2):199\u2013206. https:\/\/doi.org\/10.1016\/j.nec.2007.02.006.","journal-title":"Neurosurg Clin N Am"},{"issue":"8","key":"3481_CR2","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.2106\/00004623-200108000-00006","volume":"83","author":"LG Lenke","year":"2001","unstructured":"Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001;83(8):1169\u201381.","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"3481_CR3","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.ocl.2007.06.001","volume":"38","author":"PS Rose","year":"2007","unstructured":"Rose PS, Lenke LG. Classification of operative adolescent idiopathic scoliosis: treatment guidelines. Orthop Clin North Am. 2007;38(4):521-9, vi. https:\/\/doi.org\/10.1016\/j.ocl.2007.06.001.","journal-title":"Orthop Clin North Am"},{"issue":"20","key":"3481_CR4","doi-asserted-by":"publisher","first-page":"S217","DOI":"10.1097\/01.Brs.0000092461.11181.Cd","volume":"28","author":"PO Newton","year":"2003","unstructured":"Newton PO, Faro FD, Lenke LG, et al. Factors involved in the decision to perform a selective versus nonselective fusion of Lenke 1B and 1\u00a0C (King-Moe II) curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2003;28(20):S217\u201323. https:\/\/doi.org\/10.1097\/01.Brs.0000092461.11181.Cd.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"16","key":"3481_CR5","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1097\/BRS.0b013e3182987360","volume":"38","author":"CH Crawford","year":"2013","unstructured":"Crawford CH 3rd, Lenke LG, Sucato DJ, et al. Selective thoracic fusion in Lenke 1\u00a0C curves: prevalence and criteria. Spine (Phila Pa 1976). 2013;38(16):1380\u20135. https:\/\/doi.org\/10.1097\/BRS.0b013e3182987360.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"3481_CR6","doi-asserted-by":"publisher","first-page":"721","DOI":"10.3171\/2015.1.Spine141020","volume":"23","author":"AJ Boniello","year":"2015","unstructured":"Boniello AJ, Hasan S, Yang S, Jalai CM, Worley N, Passias PG. Selective versus nonselective thoracic fusion in Lenke 1\u00a0C curves: a meta-analysis of baseline characteristics and postoperative outcomes. J Neurosurg Spine. 2015;23(6):721\u201330. https:\/\/doi.org\/10.3171\/2015.1.Spine141020.","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"3481_CR7","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.spinee.2011.10.024","volume":"12","author":"Y Wang","year":"2012","unstructured":"Wang Y, B\u00fcnger CE, Zhang Y, Wu C, Hansen ES. Postoperative spinal alignment remodeling in Lenke 1\u00a0C scoliosis treated with selective thoracic fusion. Spine J. 2012;12(1):73\u201380. https:\/\/doi.org\/10.1016\/j.spinee.2011.10.024.","journal-title":"Spine J"},{"issue":"12","key":"3481_CR8","doi-asserted-by":"publisher","first-page":"2239","DOI":"10.1016\/j.spinee.2018.05.007","volume":"18","author":"MK Kwan","year":"2018","unstructured":"Kwan MK, Chiu CK, Tan PH, et al. Radiological and clinical outcome of selective thoracic fusion for patients with Lenke 1\u00a0C and 2\u00a0C adolescent idiopathic scoliosis with a minimum follow-up of 2 years. Spine J. 2018;18(12):2239\u201346. https:\/\/doi.org\/10.1016\/j.spinee.2018.05.007.","journal-title":"Spine J"},{"issue":"20","key":"3481_CR9","doi-asserted-by":"publisher","first-page":"S199","DOI":"10.1097\/01.Brs.0000092216.16155.33","volume":"28","author":"LG Lenke","year":"2003","unstructured":"Lenke LG, Edwards CC 2nd, Bridwell KH. The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine (Phila Pa 1976). 2003;28(20):S199\u2013207. https:\/\/doi.org\/10.1097\/01.Brs.0000092216.16155.33.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"7","key":"3481_CR10","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1177\/21925682221098667","volume":"12","author":"O Kaya","year":"2022","unstructured":"Kaya O, Kara D, Gok H, et al. The importance of lumbar curve flexibility and apical vertebral rotation for the prediction of spontaneous lumbar curve correction in selective thoracic fusion for Lenke type 1 and 2\u00a0C curves: retrospective cohort study with a mean Follow-Up of more than 10 years. Global Spine J. 2022;12(7):1516\u201323. https:\/\/doi.org\/10.1177\/21925682221098667.","journal-title":"Global Spine J"},{"issue":"16","key":"3481_CR11","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1097\/01.brs.0000174118.72916.96","volume":"30","author":"BK Potter","year":"2005","unstructured":"Potter BK, Kuklo TR, Lenke LG. Radiographic outcomes of anterior spinal fusion versus posterior spinal fusion with thoracic pedicle screws for treatment of Lenke type I adolescent idiopathic scoliosis curves. Spine (Phila Pa 1976). 2005;30(16):1859\u201366. https:\/\/doi.org\/10.1097\/01.brs.0000174118.72916.96.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"3481_CR12","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1097\/BRS.0b013e31826c6df4","volume":"38","author":"PO Newton","year":"2013","unstructured":"Newton PO, Marks MC, Bastrom TP, et al. Surgical treatment of Lenke 1 main thoracic idiopathic scoliosis: results of a prospective, multicenter study. Spine (Phila Pa 1976). 2013;38(4):328\u201338. https:\/\/doi.org\/10.1097\/BRS.0b013e31826c6df4.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"7","key":"3481_CR13","doi-asserted-by":"publisher","first-page":"405","DOI":"10.21037\/atm-22-573","volume":"10","author":"H Gu","year":"2022","unstructured":"Gu H, Li Y, Dai Y, Wang B. Anterior versus posterior approach in Lenke type 1 adolescent idiopathic scoliosis: a comparison of long-term follow-up outcomes. Ann Transl Med. 2022;10(7):405. https:\/\/doi.org\/10.21037\/atm-22-573.","journal-title":"Ann Transl Med"},{"issue":"6","key":"3481_CR14","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.spinee.2005.03.013","volume":"5","author":"R Levin","year":"2005","unstructured":"Levin R, Matusz D, Hasharoni A, Scharf C, Lonner B, Errico T. Mini-open thoracoscopically assisted thoracotomy versus video-assisted thoracoscopic surgery for anterior release in thoracic scoliosis and kyphosis: a comparison of operative and radiographic results. Spine J. 2005;5(6):632\u20138. https:\/\/doi.org\/10.1016\/j.spinee.2005.03.013.","journal-title":"Spine J"},{"issue":"7","key":"3481_CR15","first-page":"1297","volume":"125","author":"HQ Zhang","year":"2012","unstructured":"Zhang HQ, Gao QL, Ge L, et al. Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis. Chin Med J (Engl). 2012;125(7):1297\u2013302.","journal-title":"Chin Med J (Engl)"},{"issue":"16","key":"3481_CR16","doi-asserted-by":"publisher","first-page":"E973","DOI":"10.1097\/brs.0000000000001516","volume":"41","author":"CYW Chan","year":"2016","unstructured":"Chan CYW, Chiu CK, Kwan MK. Assessing the flexibility of the proximal thoracic segments above the potential upper instrumented vertebra using the cervical supine side bending radiographs in Lenke 1 and 2 curves for adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976). 2016;41(16):E973\u201380. https:\/\/doi.org\/10.1097\/brs.0000000000001516.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"3481_CR17","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.jspd.2018.03.010","volume":"6","author":"JT Brooks","year":"2018","unstructured":"Brooks JT, Bastrom TP, Bartley CE, et al. In search of the Ever-Elusive postoperative shoulder balance: is the T2 UIV the key? Spine Deform. 2018;6(6):707\u201311. https:\/\/doi.org\/10.1016\/j.jspd.2018.03.010.","journal-title":"Spine Deform"},{"issue":"17","key":"3481_CR18","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1097\/brs.0000000000003509","volume":"45","author":"R Munakata","year":"2020","unstructured":"Munakata R, Koseki M, Oba H, et al. Selecting the C7-LIV line vertebra as the upper instrumented vertebra for adolescent idiopathic scoliosis Lenke type 1A curves: multicenter and a minimum 2-Year Follow-up study. Spine (Phila Pa 1976). 2020;45(17):1239\u201345. https:\/\/doi.org\/10.1097\/brs.0000000000003509.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"3481_CR19","doi-asserted-by":"publisher","first-page":"857","DOI":"10.3171\/2019.5.Spine181469","volume":"31","author":"H Oba","year":"2019","unstructured":"Oba H, Takahashi J, Kobayashi S, et al. Upper instrumented vertebra to the right of the lowest instrumented vertebra as a predictor of an increase in the main thoracic curve after selective posterior fusion for the thoracolumbar\/lumbar curve in Lenke type 5\u00a0C adolescent idiopathic scoliosis: multicenter study on the relationship between fusion area and surgical outcome. J Neurosurg Spine. 2019;31(6):857\u201364. https:\/\/doi.org\/10.3171\/2019.5.Spine181469.","journal-title":"J Neurosurg Spine"},{"issue":"17","key":"3481_CR20","doi-asserted-by":"publisher","first-page":"E1031","DOI":"10.1097\/brs.0000000000003088","volume":"44","author":"JA Sielatycki","year":"2019","unstructured":"Sielatycki JA, Cerpa M, Beauchamp EC, et al. The amount of relative curve correction is more important than upper instrumented vertebra selection for ensuring postoperative shoulder balance in Lenke type 1 and type 2 adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2019;44(17):E1031\u20137. https:\/\/doi.org\/10.1097\/brs.0000000000003088.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"3481_CR21","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1007\/s43390-020-00147-9","volume":"8","author":"A Hiett","year":"2020","unstructured":"Hiett A, Tung R, Emanuelli E, Sherman A, Anderson JT, Schwend RM. The amount of surgical correction of the main thoracic curve is the best predictor of postoperative clinical shoulder balance in patients with adolescent idiopathic scoliosis. Spine Deform. 2020;8(6):1279\u201386. https:\/\/doi.org\/10.1007\/s43390-020-00147-9.","journal-title":"Spine Deform"},{"issue":"5","key":"3481_CR22","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1097\/01.Brs.0000048653.75549.40","volume":"28","author":"SI Suk","year":"2003","unstructured":"Suk SI, Lee SM, Chung ER, Kim JH, Kim WJ, Sohn HM. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976). 2003;28(5):484\u201391. https:\/\/doi.org\/10.1097\/01.Brs.0000048653.75549.40.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"22","key":"3481_CR23","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.2106\/jbjs.19.01485","volume":"102","author":"EC Beauchamp","year":"2020","unstructured":"Beauchamp EC, Lenke LG, Cerpa M, Newton PO, Kelly MP, Blanke KM. Selecting the touched vertebra as the lowest instrumented vertebra in patients with Lenke Type-1 and 2 curves: radiographic results after a minimum 5-Year Follow-up. J Bone Joint Surg Am. 2020;102(22):1966\u201373. https:\/\/doi.org\/10.2106\/jbjs.19.01485.","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"3481_CR24","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1177\/21925682221091744","volume":"13","author":"S Ifthekar","year":"2023","unstructured":"Ifthekar S, Ahuja K, Sudhakar PV, et al. Is it safe to save levels and choose the lowest instrumented vertebra as touched vertebra while selectively fusing Lenke 1\/2 curves? A proportional Meta-Analysis of existing evidence. Global Spine J. 2023;13(1):219\u201326. https:\/\/doi.org\/10.1177\/21925682221091744.","journal-title":"Global Spine J"},{"issue":"4","key":"3481_CR25","doi-asserted-by":"publisher","first-page":"902","DOI":"10.14245\/ns.2040234.117","volume":"17","author":"CW Liu","year":"2020","unstructured":"Liu CW, Lenke LG, Tan LA, et al. Selection of the lowest instrumented vertebra and relative odds ratio of distal Adding-on for Lenke type 1A and 2A curves in adolescent idiopathic scoliosis: A systematic review and Meta-analysis. Neurospine. 2020;17(4):902\u20139. https:\/\/doi.org\/10.14245\/ns.2040234.117.","journal-title":"Neurospine"},{"issue":"8","key":"3481_CR26","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1097\/brs.0000000000004206","volume":"47","author":"X Qin","year":"2022","unstructured":"Qin X, Qiu Y, He Z, Yin R, Liu Z, Zhu Z. Can we stop distally at LSTV-1 for adolescent idiopathic scoliosis with Lenke 1A\/2A curves? Spine (Phila Pa 1976). 2022;47(8):624\u201331. https:\/\/doi.org\/10.1097\/brs.0000000000004206.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"7","key":"3481_CR27","doi-asserted-by":"publisher","first-page":"2574","DOI":"10.1007\/s00586-023-07763-9","volume":"32","author":"E Andre","year":"2023","unstructured":"Andre E, De Courtivron B, Bergerault F, Abelin-Genevois K, Odent T. Influence of the thoracolumbar junction flexibility on the risk of adding-on after posterior vertebral arthrodesis for thoracic idiopathic adolescent scoliosis. Eur Spine J. 2023;32(7):2574\u20139. https:\/\/doi.org\/10.1007\/s00586-023-07763-9.","journal-title":"Eur Spine J"},{"issue":"11","key":"3481_CR28","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1097\/brs.0000000000002423","volume":"43","author":"M Yang","year":"2018","unstructured":"Yang M, Zhao Y, Yin X, Prevalence, et al. Risk Factors, and characteristics of the Adding-On phenomenon in idiopathic scoliosis after correction surgery: A systematic review and Meta-Analysis. Spine (Phila Pa 1976). 2018;43(11):780\u201390. https:\/\/doi.org\/10.1097\/brs.0000000000002423.","journal-title":"Spine (Phila Pa 1976)"},{"key":"3481_CR29","doi-asserted-by":"publisher","first-page":"123417","DOI":"10.1016\/j.wneu.2024.10.146","volume":"194","author":"W Guo","year":"2025","unstructured":"Guo W, Yang W, Ma R, et al. Construction and validation of a nomogram for predicting the Adding-On phenomenon postoperatively for adolescent idiopathic scoliosis: A retrospective study. World Neurosurg. 2025;194:123417. https:\/\/doi.org\/10.1016\/j.wneu.2024.10.146.","journal-title":"World Neurosurg"},{"issue":"4","key":"3481_CR30","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1007\/s00586-023-07617-4","volume":"32","author":"C Berlin","year":"2023","unstructured":"Berlin C, Quante M, Halm H. Influence of posterior instrumented correction with pedicle screw dual rod systems on thoracic kyphosis in Lenke 1 and 2 curves: minimum 2 years follow-up. Eur Spine J. 2023;32(4):1187\u201395. https:\/\/doi.org\/10.1007\/s00586-023-07617-4.","journal-title":"Eur Spine J"},{"issue":"3","key":"3481_CR31","doi-asserted-by":"publisher","first-page":"214","DOI":"10.3171\/2008.11.Spine08524","volume":"10","author":"M Li","year":"2009","unstructured":"Li M, Gu S, Ni J, Fang X, Zhu X, Zhang Z. Shoulder balance after surgery in patients with Lenke type 2 scoliosis corrected with the segmental pedicle screw technique. J Neurosurg Spine. 2009;10(3):214\u20139. https:\/\/doi.org\/10.3171\/2008.11.Spine08524.","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"3481_CR32","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1186\/s12891-017-1730-y","volume":"18","author":"J Jiang","year":"2017","unstructured":"Jiang J, Qian BP, Qiu Y, Wang B, Yu Y, Zhu ZZ. Full fusion of proximal thoracic curve helps to prevent postoperative cervical Tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder. BMC Musculoskelet Disord. 2017;18(1):362. https:\/\/doi.org\/10.1186\/s12891-017-1730-y.","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"3481_CR33","doi-asserted-by":"publisher","first-page":"16996","DOI":"10.1038\/s41598-022-21274-5","volume":"12","author":"T Mimura","year":"2022","unstructured":"Mimura T, Ikegami S, Banno T, et al. Usefulness of modified S-line for upper instrumented vertebra selection in adolescent idiopathic scoliosis Lenke type 2 curves. Sci Rep. 2022;12(1):16996. https:\/\/doi.org\/10.1038\/s41598-022-21274-5.","journal-title":"Sci Rep"},{"issue":"10","key":"3481_CR34","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.1007\/s00586-007-0397-8","volume":"16","author":"H Behensky","year":"2007","unstructured":"Behensky H, Cole AA, Freeman BJ, Grevitt MP, Mehdian HS, Webb JK. Fixed lumbar apical vertebral rotation predicts spinal decompensation in Lenke type 3\u00a0C adolescent idiopathic scoliosis after selective posterior thoracic correction and fusion. Eur Spine J. 2007;16(10):1570\u20138. https:\/\/doi.org\/10.1007\/s00586-007-0397-8.","journal-title":"Eur Spine J"},{"issue":"24","key":"3481_CR35","doi-asserted-by":"publisher","first-page":"2034","DOI":"10.1097\/brs.0000000000000623","volume":"39","author":"A Singla","year":"2014","unstructured":"Singla A, Bennett JT, Sponseller PD, et al. Results of selective thoracic versus nonselective fusion in Lenke type 3 curves. Spine (Phila Pa 1976). 2014;39(24):2034\u201341. https:\/\/doi.org\/10.1097\/brs.0000000000000623.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"22","key":"3481_CR36","doi-asserted-by":"publisher","first-page":"1850","DOI":"10.1097\/brs.0000000000000535","volume":"39","author":"KW Chang","year":"2014","unstructured":"Chang KW, Chen YY, Wu CM, Leng X, Chen TC. Could structural and noncompensatory Lenke 3 and 4\u00a0C lumbar curves be nonstructural and compensatory? Lenke 1, 2, 3, and 4 curve types were similar and could be considered collectively as a single indication for selective thoracic fusion. Spine (Phila Pa 1976). 2014;39(22):1850\u20139. https:\/\/doi.org\/10.1097\/brs.0000000000000535.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"3481_CR37","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1007\/s00264-011-1331-6","volume":"36","author":"Y Wang","year":"2012","unstructured":"Wang Y, B\u00fcnger CE, Zhang Y, Hansen ES. Extensive fusion for Lenke 3\u00a0C and 6\u00a0C scoliosis: a two year radiographic follow-up. Int Orthop. 2012;36(4):795\u2013801. https:\/\/doi.org\/10.1007\/s00264-011-1331-6.","journal-title":"Int Orthop"},{"issue":"6","key":"3481_CR38","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1097\/bpb.0000000000000696","volume":"29","author":"A Duramaz","year":"2020","unstructured":"Duramaz A, Karaali E, \u00d6zt\u00fcrk V, Ziro\u011flu N, \u0130lter MH, Bayrak A. Importance of lowest instrumented vertebra on clinical and radiological outcomes in patients with Lenke type 3\u00a0C adolescent idiopathic scoliosis: a minimum 4-year follow-up. J Pediatr Orthop B. 2020;29(6):580\u20139. https:\/\/doi.org\/10.1097\/bpb.0000000000000696.","journal-title":"J Pediatr Orthop B"},{"issue":"9","key":"3481_CR39","doi-asserted-by":"publisher","first-page":"519","DOI":"10.5435\/jaaos-21-09-519","volume":"21","author":"PD Trobisch","year":"2013","unstructured":"Trobisch PD, Ducoffe AR, Lonner BS, Errico TJ. Choosing fusion levels in adolescent idiopathic scoliosis. J Am Acad Orthop Surg. 2013;21(9):519\u201328. https:\/\/doi.org\/10.5435\/jaaos-21-09-519.","journal-title":"J Am Acad Orthop Surg"},{"issue":"6","key":"3481_CR40","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1007\/s00586-011-2058-1","volume":"21","author":"Y Wang","year":"2012","unstructured":"Wang Y, B\u00fcnger CE, Zhang Y, Hansen ES. Lowest instrumented vertebra selection in Lenke 3\u00a0C and 6\u00a0C scoliosis: what if we choose lumbar apical vertebra as distal fusion end? Eur Spine J. 2012;21(6):1053\u201361. https:\/\/doi.org\/10.1007\/s00586-011-2058-1.","journal-title":"Eur Spine J"},{"issue":"4","key":"3481_CR41","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1007\/s43390-023-00651-8","volume":"11","author":"S Chilakapati","year":"2023","unstructured":"Chilakapati S, Poppino K, Jo C, Sucato DJ. Surgical treatment of double major adolescent idiopathic scoliosis can lead to excessive lumbar lordosis in the instrumented segments. Spine Deform. 2023;11(4):969\u201375. https:\/\/doi.org\/10.1007\/s43390-023-00651-8.","journal-title":"Spine Deform"},{"issue":"3","key":"3481_CR42","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1227\/neu.0000000000001055","volume":"78","author":"Y Dong","year":"2016","unstructured":"Dong Y, Weng X, Zhao H, Zhang J, Shen J, Qiu G. Lenke 5\u00a0C curves in adolescent idiopathic scoliosis: anterior vs posterior selective fusion. Neurosurgery. 2016;78(3):324\u201331. https:\/\/doi.org\/10.1227\/neu.0000000000001055.","journal-title":"Neurosurgery"},{"issue":"1","key":"3481_CR43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00402-016-2570-1","volume":"137","author":"Y Zhang","year":"2017","unstructured":"Zhang Y, Lin G, Zhang J, et al. Radiographic evaluation of posterior selective thoracolumbar or lumbar fusion for moderate Lenke 5\u00a0C curves. Arch Orthop Trauma Surg. 2017;137(1):1\u20138. https:\/\/doi.org\/10.1007\/s00402-016-2570-1.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"14","key":"3481_CR44","doi-asserted-by":"publisher","first-page":"E223","DOI":"10.1097\/brs.0000000000004529","volume":"48","author":"W Liang","year":"2023","unstructured":"Liang W, Han B, Sun D, et al. Surgical treatment of scoliosis Lenke type 5, anterior versus Posterior, which approach is better? A systematic review and Meta-Analysis. Spine (Phila Pa 1976). 2023;48(14):E223\u201334. https:\/\/doi.org\/10.1097\/brs.0000000000004529.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"3481_CR45","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.spinee.2015.08.021","volume":"16","author":"H Sudo","year":"2016","unstructured":"Sudo H, Kaneda K, Shono Y, Iwasaki N. Selection of the upper vertebra to be instrumented in the treatment of thoracolumbar and lumbar adolescent idiopathic scoliosis by anterior correction and fusion surgery using dual-rod instrumentation: a minimum 12-year follow-up study. Spine J. 2016;16(3):281\u20137. https:\/\/doi.org\/10.1016\/j.spinee.2015.08.021.","journal-title":"Spine J"},{"issue":"1","key":"3481_CR46","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1097\/brs.0000000000000652","volume":"40","author":"E Okada","year":"2015","unstructured":"Okada E, Watanabe K, Pang L, et al. Posterior correction and fusion surgery using pedicle-screw constructs for Lenke type 5\u00a0C adolescent idiopathic scoliosis: a preliminary report. Spine (Phila Pa 1976). 2015;40(1):25\u201330. https:\/\/doi.org\/10.1097\/brs.0000000000000652.","journal-title":"Spine (Phila Pa 1976)"},{"key":"3481_CR47","doi-asserted-by":"publisher","unstructured":"Shu S, Zhang T, Jing W, et al. Hyper-selective posterior fusion in Lenke 5\u00a0C adolescent idiopathic scoliosis: when can we stop below the upper end vertebra? Spine (Phila Pa 1976). 2020;45(18):1269\u201376. https:\/\/doi.org\/10.1097\/brs.0000000000003513.","DOI":"10.1097\/brs.0000000000003513"},{"issue":"35","key":"3481_CR48","doi-asserted-by":"publisher","first-page":"2772","DOI":"10.3760\/cma.j.cn112137-20201231-03526","volume":"101","author":"HD Bao","year":"2021","unstructured":"Bao HD, Shu SB, Zhang TY, et al. [Clinical study of selection of the upper instrumented vertebra at one level caudal to upper end vertebra in patients with Lenke 5\u00a0C adolescent idiopathic scoliosis]. Zhonghua Yi Xue Za Zhi. 2021;101(35):2772\u20137. https:\/\/doi.org\/10.3760\/cma.j.cn112137-20201231-03526.","journal-title":"Zhonghua Yi Xue Za Zhi"},{"issue":"6","key":"3481_CR49","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1111\/os.14073","volume":"16","author":"Q Gu","year":"2024","unstructured":"Gu Q, Bao H, Shu S, Zhang X, Qiu Y, Zhu Z. Hyper-Selective posterior fusion is recommended when the modified S-Line is positive in Lenke 5\u00a0C adolescent idiopathic scoliosis. Orthop Surg. 2024;16(6):1390\u20138. https:\/\/doi.org\/10.1111\/os.14073.","journal-title":"Orthop Surg"},{"issue":"29","key":"3481_CR50","doi-asserted-by":"publisher","first-page":"2239","DOI":"10.3760\/cma.j.cn112137-20221209-02607","volume":"103","author":"QD Li","year":"2023","unstructured":"Li QD, He BR, Hui H, et al. [Analysis of factors associated with proximal junctional kyphosis after surgery for Lenke type 5 adolescent idiopathic scoliosis]. Zhonghua Yi Xue Za Zhi. 2023;103(29):2239\u201345. https:\/\/doi.org\/10.3760\/cma.j.cn112137-20221209-02607.","journal-title":"Zhonghua Yi Xue Za Zhi"},{"issue":"3","key":"3481_CR51","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1302\/0301-620x.98b3.36715","volume":"98\u2013b","author":"H Sudo","year":"2016","unstructured":"Sudo H, Kaneda K, Shono Y, Iwasaki N. Short fusion strategy for thoracolumbar and lumbar adolescent idiopathic scoliosis using anterior dual-rod instrumentation. Bone Joint J. 2016;98\u2013b(3):402\u20139. https:\/\/doi.org\/10.1302\/0301-620x.98b3.36715.","journal-title":"Bone Joint J"},{"issue":"6","key":"3481_CR52","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1007\/s00586-016-4788-6","volume":"26","author":"A Dubory","year":"2017","unstructured":"Dubory A, Miladi L, Ilharreborde B, et al. Cobb-1 versus cobb-to-cobb anterior fusion for adolescent idiopathic scoliosis Lenke 5\u00a0C curves: a radiological comparative study. Eur Spine J. 2017;26(6):1711\u201320. https:\/\/doi.org\/10.1007\/s00586-016-4788-6.","journal-title":"Eur Spine J"},{"issue":"6","key":"3481_CR53","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1007\/s00586-014-3276-0","volume":"23","author":"Z Sun","year":"2014","unstructured":"Sun Z, Qiu G, Zhao Y, Wang Y, Zhang J, Shen J. Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar\/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra\u2009+\u20091? Eur Spine J. 2014;23(6):1251\u20137. https:\/\/doi.org\/10.1007\/s00586-014-3276-0.","journal-title":"Eur Spine J"},{"issue":"20","key":"3481_CR54","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.1097\/BRS.0b013e3182091fba","volume":"36","author":"J Li","year":"2011","unstructured":"Li J, Hwang SW, Shi Z, et al. Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5\u00a0C patients. Spine (Phila Pa 1976). 2011;36(20):1673\u20138. https:\/\/doi.org\/10.1097\/BRS.0b013e3182091fba.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"3481_CR55","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1186\/s12891-018-2135-2","volume":"19","author":"X Yang","year":"2018","unstructured":"Yang X, Hu B, Song Y, et al. Coronal and sagittal balance in Lenke 5 AIS patients following posterior fusion: important role of the lowest instrument vertebrae selection. BMC Musculoskelet Disord. 2018;19(1):212. https:\/\/doi.org\/10.1186\/s12891-018-2135-2.","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"3481_CR56","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.spinee.2020.08.006","volume":"21","author":"Q Zhuang","year":"2021","unstructured":"Zhuang Q, Zhang J, Wang S, Yang Y, Lin G. How to select the lowest instrumented vertebra in Lenke type 5 adolescent idiopathic scoliosis patients? Spine J. 2021;21(1):141\u20139. https:\/\/doi.org\/10.1016\/j.spinee.2020.08.006.","journal-title":"Spine J"},{"issue":"1","key":"3481_CR57","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/os.14267","volume":"17","author":"C Li","year":"2025","unstructured":"Li C, Ye X, Zhang H, et al. Is it enough to stop distal fusion at L3 in mild to moderate Lenke 5\u00a0C adolescent idiopathic scoliosis patients? Orthop Surg. 2025;17(1):105\u201314. https:\/\/doi.org\/10.1111\/os.14267.","journal-title":"Orthop Surg"},{"issue":"4","key":"3481_CR58","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.14245\/ns.2346822.411","volume":"20","author":"Z Li","year":"2023","unstructured":"Li Z, Du Y, Zhao Y, et al. Lowest instrumented vertebra at L3 versus L4 in posterior fusion for moderate Lenke 5\u00a0C type adolescent idiopathic scoliosis: A Case-Match radiological study. Neurospine. 2023;20(4):1380\u20138. https:\/\/doi.org\/10.14245\/ns.2346822.411.","journal-title":"Neurospine"},{"issue":"1","key":"3481_CR59","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1186\/s13018-023-03680-1","volume":"18","author":"J Li","year":"2023","unstructured":"Li J, Lin Z, Ma Y, Li W, Yu M. How to make a more optimal surgical plan for Lenke 5 adolescent idiopathic scoliosis patients: a comparative study based on the changes of the sagittal alignment and selection of the lowest instrumented vertebra. J Orthop Surg Res. 2023;18(1):224. https:\/\/doi.org\/10.1186\/s13018-023-03680-1.","journal-title":"J Orthop Surg Res"},{"issue":"4","key":"3481_CR60","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1007\/s00586-021-07040-7","volume":"31","author":"X Shao","year":"2022","unstructured":"Shao X, Sui W, Deng Y, Yang J, Chen J, Yang J. How to select the lowest instrumented vertebra in Lenke 5\/6 adolescent idiopathic scoliosis patients with derotation technique. Eur Spine J. 2022;31(4):996\u20131005. https:\/\/doi.org\/10.1007\/s00586-021-07040-7.","journal-title":"Eur Spine J"},{"issue":"3","key":"3481_CR61","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/bpb.0000000000000771","volume":"30","author":"SY Chang","year":"2021","unstructured":"Chang SY, Son J, Zheng GB, Chang BS, Lee CK, Kim H. Clinical outcomes of selective fusion for the thoracolumbar-lumbar curve in patients with Lenke type 6\u00a0C adolescent idiopathic scoliosis: a preliminary study. J Pediatr Orthop B. 2021;30(3):211\u20137. https:\/\/doi.org\/10.1097\/bpb.0000000000000771.","journal-title":"J Pediatr Orthop B"},{"issue":"8","key":"3481_CR62","doi-asserted-by":"publisher","first-page":"373","DOI":"10.5435\/jaaos-d-22-00547","volume":"31","author":"RJ Mistovich","year":"2023","unstructured":"Mistovich RJ, Blumenschein LA, Glotzbecker MP. Surgical level selection in adolescent idiopathic scoliosis: an Evidence-Based approach. J Am Acad Orthop Surg. 2023;31(8):373\u201381. https:\/\/doi.org\/10.5435\/jaaos-d-22-00547.","journal-title":"J Am Acad Orthop Surg"},{"issue":"8","key":"3481_CR63","doi-asserted-by":"publisher","first-page":"2054","DOI":"10.1007\/s00586-020-06353-3","volume":"29","author":"Z He","year":"2020","unstructured":"He Z, Qin X, Yin R, et al. The rotation of preoperative-presumed lowest instrumented vertebra: is it a risk factor for distal adding-on in Lenke 1A\/2A curve treated with selective thoracic fusion? Eur Spine J. 2020;29(8):2054\u201363. https:\/\/doi.org\/10.1007\/s00586-020-06353-3.","journal-title":"Eur Spine J"},{"issue":"18","key":"3481_CR64","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1097\/brs.0000000000004378","volume":"47","author":"V Sarwahi","year":"2022","unstructured":"Sarwahi V, Hasan S, Wendolowski S, et al. A newer way of determining LIV in AIS patients: rotation of the touched vertebrae. Spine (Phila Pa 1976). 2022;47(18):1321\u20137. https:\/\/doi.org\/10.1097\/brs.0000000000004378.","journal-title":"Spine (Phila Pa 1976)"},{"key":"3481_CR65","doi-asserted-by":"publisher","DOI":"10.1007\/s43390-025-01253-2","author":"CE Aubin","year":"2025","unstructured":"Aubin CE, Lenke LG, Vitale M, et al. The SRS-Lenke-Aubin 3D classification of adolescent idiopathic scoliosis. Spine Deform. 2025. https:\/\/doi.org\/10.1007\/s43390-025-01253-2.","journal-title":"Spine Deform"},{"issue":"1","key":"3481_CR66","doi-asserted-by":"publisher","first-page":"16296","DOI":"10.1038\/s41598-018-34261-6","volume":"8","author":"S Pasha","year":"2018","unstructured":"Pasha S, Flynn J. Data-driven classification of the 3D spinal curve in adolescent idiopathic scoliosis with an applications in surgical outcome prediction. Sci Rep. 2018;8(1):16296. https:\/\/doi.org\/10.1038\/s41598-018-34261-6.","journal-title":"Sci Rep"},{"issue":"1","key":"3481_CR67","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1186\/s13018-024-04848-z","volume":"19","author":"W Cui","year":"2024","unstructured":"Cui W, Liu X, Zhao Z, Feng Z, Meng X. Accuracy and postoperative assessment of robot-assisted placement of pedicle screws during scoliosis surgery compared with conventional freehand technique: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1):365. https:\/\/doi.org\/10.1186\/s13018-024-04848-z.","journal-title":"J Orthop Surg Res"},{"key":"3481_CR68","doi-asserted-by":"publisher","first-page":"124585","DOI":"10.1016\/j.wneu.2025.124585","volume":"204","author":"B Ma","year":"2025","unstructured":"Ma B, Xing S, Ma M, et al. Research on optimizing Early-Onset scoliosis correction strategies using robotic navigation technology. World Neurosurg. 2025;204:124585. https:\/\/doi.org\/10.1016\/j.wneu.2025.124585.","journal-title":"World Neurosurg"},{"key":"3481_CR69","doi-asserted-by":"publisher","first-page":"1607323","DOI":"10.3389\/fsurg.2025.1607323","volume":"12","author":"B Zheng","year":"2025","unstructured":"Zheng B, Zhou Q, Liu X, Ma K, Qiang Z. Low-density pedicle screw in adolescent idiopathic scoliosis: a systematic review and meta-analysis of 1,762 patients. Front Surg. 2025;12:1607323. https:\/\/doi.org\/10.3389\/fsurg.2025.1607323.","journal-title":"Front Surg"},{"issue":"1","key":"3481_CR70","doi-asserted-by":"publisher","first-page":"2531589","DOI":"10.1080\/08941939.2025.2531589","volume":"38","author":"Z Lu","year":"2025","unstructured":"Lu Z, Liu C, Li J, et al. The impact of screw density on the outcomes of adolescent idiopathic scoliosis correction surgery: A multicenter retrospective study. J Invest Surg. 2025;38(1):2531589. https:\/\/doi.org\/10.1080\/08941939.2025.2531589.","journal-title":"J Invest Surg"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-025-03481-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-03481-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-03481-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T12:28:02Z","timestamp":1770121682000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12893-025-03481-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":70,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3481"],"URL":"https:\/\/doi.org\/10.1186\/s12893-025-03481-9","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]},"assertion":[{"value":"21 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This study is a narrative review of previously published literature and does not involve human participants or animals.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"102"}}