Fusion Length in Scoliosis Surgery [10:21]
Published on October 29, 2026
Case Discussion
Case discussion from WST The Summit 2026 in which Stefan Hemmer presents a 14-year-old girl with severe double major adolescent idiopathic scoliosis (AIS): a 73-degree thoracic and 72-degree thoracolumbar curve, unbalanced shoulders and good flexibility on bending and traction X-rays. He summarizes how to choose the upper instrumented vertebra (UIV) by Lenke type and shoulder level (T2, T3 or T4) and the lower instrumented vertebra (LIV) using the last substantially touched vertebra. Julian Leong recommends an anterior T11–L3 fusion of the thoracolumbar curve to stop at L3, while Tobias Schulte suggests an anterior release with one XLIF followed by posterior instrumentation from T2 to L3. The family chose the safe option: posterior fusion from T2 to L4 with wide Ponte osteotomies, achieving good coronal and sagittal balance. A practical debate on fusion level selection and preserving lumbar motion segments for spine surgeons treating AIS.
#AdolescentIdiopathicScoliosis #Scoliosis #FusionLevelSelection #LenkeClassification #SpinalFusion #PonteOsteotomy #DeformityCorrection #ThoracolumbarSpine #AdjacentSegmentDegeneration #CaseDiscussion #SpineSurgery
Case discussion from WST The Summit 2026 in which Stefan Hemmer presents a 14-year-old girl with severe double major adolescent idiopathic scoliosis (AIS): a 73-degree thoracic and 72-degree thoracolumbar curve, unbalanced shoulders and good flexibility on bending and traction X-rays. He summarizes how to choose the upper instrumented vertebra (UIV) by Lenke type and shoulder level (T2, T3 or T4) and the lower instrumented vertebra (LIV) using the last substantially touched vertebra. Julian Leong recommends an anterior T11–L3 fusion of the thoracolumbar curve to stop at L3, while Tobias Schulte suggests an anterior release with one XLIF followed by posterior instrumentation from T2 to L3. The family chose the safe option: posterior fusion from T2 to L4 with wide Ponte osteotomies, achieving good coronal and sagittal balance. A practical debate on fusion level selection and preserving lumbar motion segments for spine surgeons treating AIS.
#AdolescentIdiopathicScoliosis #Scoliosis #FusionLevelSelection #LenkeClassification #SpinalFusion #PonteOsteotomy #DeformityCorrection #ThoracolumbarSpine #AdjacentSegmentDegeneration #CaseDiscussion #SpineSurgery
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