Chee Kidd Chiu, Chin Siong Tan, Weng Hong Chung, Siti Mariam Mohamad, Mun Keong Kwan, Chris Yin Wei Chan

July 2021, Volume 30, Issue 7, pp 1978 - 1987 Original Article Read Full Article 10.1007/s00586-021-06874-5

First Online: 22 May 2021


To investigate mid-long-term effects of the lowest instrumented vertebra (LIV) selection on adolescent idiopathic scoliosis (AIS) patients who had posterior spinal fusion (PSF) surgery.


Forty-eight patients were recruited. Inclusion criteria were AIS patients who have had PSF surgery more than 10 years ago. Patients were divided into G1: LIV L3 or higher and G2: LIV L4 or lower. MRI evaluation was classified using Pfirrmann grades. Pfirrmann scores were average of Pfirrmann grades for all unfused discs below LIV. SRS-22r, SF-36, Oswestry Disability Index (ODI) and Modified Cincinnati Sports Activity Scale (MCSAS) were used.


There were 19 patients in G1 and 29 patients in G2. Demographic parameters showed no significant differences. We found no significant differences in Pfirrmann grades or scores between G1 and G2. There was significant correlation between age and mean Pfirrmann scores (r = 0.546, p 


Patients with fusion to L4 or lower had more significant back pain. However, both groups had similar physical function, self-image, satisfaction with treatment, mental health, and functional sports activity. We did not find any significant association between lumbar discs degeneration and the selection of LIV.

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