Surgical decision making in adolescent idiopathic scoliosis

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2 Scopus citations


Regardless of the implant, the approach, the surgeon, and the patient, the ideal fusion is one in which the top and the bottom of the fusion are intersected by the center sacral line and the plumb line in the coronal plane. In the sagittal plane, segmental physiologic lordosis should be achieved. The shoulders should be level. The top and the bottom of the fusion should preferably be neutral and in the middle and distal lumbar spine in particular the last instrumented vertebra should be horizontal to the sacrum and preferably bisected by the center sacral line to reduce asymmetric loads on the distal lumbar discs. The incidence of intraoperative neurological deficits is low with idiopathic scoliosis, but some form of monitoring of both the posterior columns and anterior motor tracts should be performed. Simply somatosensory potential monitoring is not adequate. A combination of somatosensory and motor potential monitoring should be performed with a provision for Stagnara wake-up tests.

Original languageEnglish
Pages (from-to)130-140
Number of pages11
JournalSeminars in Spine Surgery
Issue number2
StatePublished - Jan 1 1997


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