In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • TEAMS: An Algorithm for Fusion Level Selection in Idiopathic Adolescent Scoliosis Surgery

    Final Number:
    140

    Authors:
    Ryan Gregory Nazar MD

    Study Design:
    Other

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves 2016 Annual Meeting

    Introduction: The purpose of this study is to review the literature to determine guidelines for selection of fusion levels in adolescent idiopathic scoliosis (AIS). The mnemonic TEAMS is introduced as an algorithm for decision making when trying to determine fusion levels and includes: Type of curve, End of cobb angle, Avoiding kyphotic apex, Mobile disc segment below fusion, Stable zone of Harrington for end points.

    Methods: We conducted systematic review of publications evaluating the surgical treatment of AIS for the period of 1950 to 2015.

    Results: A total of 6 classification systems of AIS curves types were identified; highlighting pertinent and significant contributions that determine correct fusion level selection as well as identifying limitations and potential improvements (Table 1). Classification and treatment has changed over time as evident in Table 1 because our understanding of correct fusion level determination in AIS has evolved over time. Table 2 demonstrates a natural evolution of important concepts that have been realized in AIS management that were categorized into the general concepts for selecting fusion level. Most of the literature on this subject comes from level 4 studies that are case series. In order to simplify understanding of a complex topic, determine guidelines for fusion levels, and provide a framework for future concepts that emerge; we categorized current understanding and parameters based upon our literature review to create the mnemonic TEAMS (Table 3)

    Conclusions: The TEAMS mnemonic provides a simple guide to understanding and determining fusion levels for AIS based upon a balanced curve correction and leaving the maximum number of mobile vertebral segments. Residents, fellows, and spine surgeons can benefit from the decision-making algorithm presented here. Further research is needed to evaluate the long-term outcomes, versatility, reliability, and accuracy of our method for defining the vertebrae to be included for arthrodesis.

    Patient Care: The evolution of classification systems and concepts through time demonstrated by Tables 1 and 2 only helps to support that selection of fusion for thoracic and thoracolumbar/lumbar curves in AIS is a concept that is critically debated and difficult to apply in practice. Our study reviews the literature serving as an introduction to determining which patients should undergo selective fusion and which vertebrae should be included in that fusion. In order to simplify understanding of a complex topic, determine guidelines for fusion levels, and provide a framework for future concepts that emerge; we categorized current understanding and parameters based upon our literature review to create the mnemonic TEAMS.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the selection of fusion levels in AIS. 2) Identify curve types as structural or non-structural; rigid, semi-rigid, or flexible. 3) Apply the TEAMS algorithm to case examples

    References: Arlet V, Marchesi D, Papin P, Aebi M. Decompensation following scoliosis surgery: treatment by decreasing the correction of the main thoracic curve or “letting the spine go” Eur Spine J. 2000;9:156– 160. Bridwell KH, McAllister JW, Betz RR, Huss G, Clancy M, Schoenecker PL. Coronal decompensation produced by Cotrel–Dubousset “derotation” maneuver for idiopathic right thoracic scoliosis. Spine (Phila Pa 1976) 1991;16:769–777. Goldstein LA (1973) The surgical treatment of idiopathic scoliosis. Clin Orthop Relat Res 93. Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2004;29:2040– 2048. Kim YL, Lenke LG, Bridwell KH, Boachie-Adjei O, Clements J, Cho SK, Cha TD, Fischer CR (2010) Stable vertebra for surgical management of adolescent idiopathic scoliosis: how much stable is enough? Transactions of the SRS/IMAST. Kim YJ, Bridwell KH, Lenke LG, Kim J, Cho SK. Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine. 2005;30:2045–2050. King HA, Moe JH, Bradford DS, Winter RB. The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Jt Surg Am. 1983;65:1302–1313. King HA. Selection of fusion levels for posterior instrumentation and fusion in idiopathic scoliosis. Orthop Clin North Am. 1988;19:247–255. Knapp DR, Jr, Price CT, Jones ET, Coonrad RW, Flynn JC. Choosing fusion levels in progressive thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 1992;17:1159–1165. Lenke LG, Betz RR, Clements D, Merola A, Haher T, Lowe T, Newton P, Bridwell KH, Blanke K. Curve prevalence of a new classification of operative adolescent idiopathic scoliosis: does classification correlate with treatment? Spine. 2002;27:604–611 . 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. 2003;28:S199– S207. Lenke LG, Betz RR, Bridwell KH, Harms J, Clements DH, Lowe TG. Spontaneous lumbar curve coronal correction after selective anterior or posterior thoracic fusion in adolescent idiopathic scoliosis. Spine. 1999;24:1663–1672. Moore MR, Baynham GC, Brown CW, Donaldson DH, Odom JA., Jr Analysis of factors related to truncal decompensation following Cotrel–Dubousset instrumentation. J Spinal Disord. 1991;4:188–192. Nash CL Jr, Moe JH. A study of vertebral rotation. J Bone Joint Surg [Am] 1969;51-A:223-9. Ponseti IV, Friedman B. Prognosis in idiopathic scoliosis. J Bone Joint Surg [Am] 1950;32-A:381-95. Poncet P, Dansereau J, Labelle H. Geometric torsion in idiopathic scoliosis: three-dimensional analysis and proposal for a new classification. Spine2001;26:2235-43. Puno RM, Grossfeld SL, Johnson JR, Holt RT. Cotrel–Dubousset instrumentation in idiopathic scoliosis. Spine (Phila Pa 1976) 1992;17:258–262. Qiu G, Zhang J, Wang Y, et al. A new operative classification of idiopathic scoliosis: a peking union medical college method. Spine 2005;30:1419-26. Sanders AE, Baumann R, Brown H, Johnston CE, 2nd, Lenke LG, Sink E. Selective anterior fusion of thoracolumbar/lumbar curves in adolescents: when can the associated thoracic curve be left unfused? Spine. 2003;28:706–713. Schulte TL, Liljenqvist U, Hierholzer E, Bullmann V, Halm HF, Lauber S, Hackenberg L. Spontaneous correction and derotation of secondary curves after selective anterior fusion of idiopathic scoliosis. Spine. 2006;31:315–321. Suk S-I, Lee S-M, Chung E-R, Kim J-H, Kim S-S. Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis: more than 5-year follow-up. Spine. 2005;30:1602–1609. Wang T, Xu J-G, Zeng B-F. Selective fusion in adolescent idiopathic scoliosis. Chin Med J. 2008;121:1456– 1461.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy