From the Research
In scoliosis treatment, the stable vertebra is typically defined as the most cephalad (uppermost) vertebra touched by the central sacral vertical line (CSVL) and is usually the lowest vertebra included in the fusion construct during surgical correction, as supported by the most recent study 1.
Importance of Stable Vertebra in Scoliosis Treatment
The stable vertebra serves as a reference point for surgical correction planning, ensuring that the spine is fused to a level that will provide adequate stability while preserving as much spinal mobility as possible.
- The identification of the stable vertebra involves radiographic assessment, including standing full-spine X-rays, and consideration of curve flexibility, skeletal maturity, and curve pattern.
- Fusing below the stable vertebra may be unnecessary and could limit patient mobility, while stopping the fusion above this level might lead to inadequate correction or progression of the curve.
Recent Study Findings
A recent study 1 found that including the stable sagittal vertebra in the fusion for adolescent idiopathic scoliosis reduces the risk of distal junctional kyphosis in Lenke 1-3 B and C curves.
- The study reported that patients fused short of the stable sagittal vertebra had a 9.2 times increased risk of developing distal junctional kyphosis at 2 years compared to patients with fusions including the stable sagittal vertebra.
- However, patients with fusions short of the stable sagittal vertebra and no evidence of distal junctional kyphosis were more likely to have improvement in the SRS-22 pain domain compared to patients with fusions including the distal stable sagittal vertebra.
Clinical Implications
The findings of this study 1 have important implications for the treatment of scoliosis, highlighting the importance of careful selection of the lowest instrumented vertebra to minimize the risk of complications and optimize patient outcomes.
- The study suggests that including the stable sagittal vertebra in the fusion construct can reduce the risk of distal junctional kyphosis, while also considering the potential impact on patient-reported outcomes.