{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T18:57:25Z","timestamp":1777489045786,"version":"3.51.4"},"reference-count":16,"publisher":"Korean Neurosurgical Society","issue":"5","license":[{"start":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T00:00:00Z","timestamp":1627430400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["jkns.or.kr"],"crossmark-restriction":true},"short-container-title":["J Korean Neurosurg Soc"],"published-print":{"date-parts":[[2021,9,1]]},"abstract":"<jats:p>Objective : The purpose of this study was to identify risk factors for distal adding on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by posterior spinal fusion (PSF) to L3 with a minimum 2-year follow-up.Methods : AIS patients undergoing PSF to L3 by two senior surgeons from 2000\u20132010 were analyzed. Distal AO and DJK were deemed poor radiographic results and defined as &gt;3 cm of deviation from L3 to the center sacral vertical line (CSVL), or &gt;10\u00b0 angle at L3\u20134 on the posterior anterior- or lateral X-ray at ultimate follow-up. New stable vertebra (SV) and neutral vertebra (NV) scores were defined for this study. The total stability (TS) score was the sum of the SV and NV scores.Results : Ten of 76 patients (13.1%) were included in the poor radiographic outcome group. The other 66 patients were included in the good radiographic outcome group. Lower Risser grade, more SV-3 (CSVL doesn\u2019t touch the lowest instrumented vertebra [LIV]) on standing and side bending films, lesser NV and TS score, rigid L3\u20134 disc, more rotation and deviation of L3 were identified risk factors for AO or DJK. Age, number of fused vertebrae, curve correction, preoperative coronal\/sagittal L3\u20134 disc angle did not differ significantly between the two groups. Multiple logistic regression results indicated that preoperative Risser grade 0, 1 (odds ratio [OR], 1.8), SV-3 at L3 in standing and side benders (OR, 2.1 and 2.8, respectively), TS score -5, -6 at L3 (OR, 4.4), rigid disc at L3\u20134 (OR, 3.1), LIV rotation &gt;15\u00b0 (OR, 2.9), and LIV deviation &gt;2 cm from CSVL (OR, 2.2) were independent predictive factors. Although there was significant improvement of the of Scoliosis Research Society-22 average scores only in the good radiographic outcome group, there was no significant difference in the scores between the groups.Conclusion : The prevalence of AO or DJK at ultimate follow-up for AIS with LIV at L3 was 13.1%. To prevent AO or DJK following fusion to L3, we recommend that the CSVL touch L3 in both standing and side bending, TS score is -4 or less, the L3\/4 disc is flexible, L3 is neutral (&lt;15\u00b0) and \u22642 cm from the midline and the patient is \u2265 Risser 2.<\/jats:p>","DOI":"10.3340\/jkns.2020.0348","type":"journal-article","created":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T01:17:42Z","timestamp":1630545462000},"page":"776-783","update-policy":"https:\/\/doi.org\/10.3340\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable?"],"prefix":"10.3340","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2937-5300","authenticated-orcid":true,"given":"Seung-Jae","family":"Hyun","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5595-4958","authenticated-orcid":true,"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1647-3286","authenticated-orcid":true,"given":"Yongjung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9228-8782","authenticated-orcid":true,"given":"Keith H.","family":"Bridwell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5931-7067","authenticated-orcid":true,"given":"Meghan","family":"Cerpa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7748-0693","authenticated-orcid":true,"given":"Kathy M.","family":"Blanke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1892","reference":[{"key":"ref1","first-page":"591","volume-title":"Treatment of scoliosis. Correction and internal fixation by spine instrumentation","author":"Harrington","year":"1962"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-010-1320-2"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2040476.238"},{"key":"ref4","volume-title":"Optimal lowest instrumented vertebra to avoid adding\u2010on or distal junctional kyphosis for thoracic adolescent idiopathic scoliosis","author":"Kim"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198365090-00012"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.14245\/ns.2040392.196"},{"key":"ref7","first-page":"1169","volume-title":"Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis","author":"Lenke","year":"2001"},{"key":"ref8","volume-title":"Reliability analysis of end, neutral, stable, and lowest instrumented vertebrae selection in adolescent idiopathic scoliosis: Surgeon versus digital software determination","author":"Lenke"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1097\/00002517-199306040-00008"},{"key":"ref10","volume-title":"Radiographic results of selecting the touched vertebra as the lowest instrumented vertebra in Lenke 1A AIS curves at a minimum fiveyear follow up","author":"Lenke"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2019.0218"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3928\/0147-7447-19870601-10"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000001374"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000048653.75549.40"},{"key":"ref15","first-page":"1113","volume-title":"Distal adding-on phenomenon in Lenke 1A scoliosis: risk factor identification and treatment strategy comparison","author":"Wang","year":"2011"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.14245\/ns.1938100.050"}],"container-title":["Journal of Korean Neurosurgical Society"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/jkns.or.kr\/upload\/pdf\/jkns-2020-0348.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/jkns.or.kr\/journal\/view.php?doi=10.3340\/jkns.2020.0348","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/jkns.or.kr\/upload\/pdf\/jkns-2020-0348.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T07:49:34Z","timestamp":1631173774000},"score":1,"resource":{"primary":{"URL":"http:\/\/jkns.or.kr\/journal\/view.php?doi=10.3340\/jkns.2020.0348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,1]]},"references-count":16,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,9]]}},"URL":"https:\/\/doi.org\/10.3340\/jkns.2020.0348","relation":{},"ISSN":["2005-3711","1598-7876"],"issn-type":[{"value":"2005-3711","type":"print"},{"value":"1598-7876","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,1]]},"assertion":[{"value":"2020-12-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-28","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-01","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}