Letter to the Editor RE: The Mid-term Outcome of Intervertebral Disc Degeneration after Direct Vertebral Rotation in Adolescent Idiopathic Scoliosis: Magnetic Resonance Imaging-based Analysis for a Mean 11.6-year Follow-up.

STUDY DESIGN:A retrospective cohort study. OBJECTIVE:To evaluate the mid-term effect of intervertebral disc degeneration (DD) in adolescent idiopathic scoliosis (AIS) patients who underwent pedicle screw instrumentation (PSI) and rod derotation (RD) with direct vertebral rotation (DVR). SUMMARY OF BACKGROUND DATA:Posterior spinal fusion is a mainstay of surgical treatment in AIS, and DVR is considered a main corrective maneuver for vertebral rotation. However, the mid-term effect of intervertebral DD after DVR is still unknown in AIS. METHODS:A total of 336 vertebrae for 48 AIS patients who underwent PSI and RD with DVR were retrospectively assessed for intervertebral DD. They were divided into two groups based upon intervertebral DD, defined as Pfirmann grade more than IV. The Pfirrmann grade and modic change were evaluated at the disc above the uppermost instrumented vertebra (UIV), the disc below the lowest instrumented vertebra (LIV), and the lumbar disc levels. RESULTS:With the 11.6 years of mean follow-up, 41.7% (20/48) of patients exhibited DD, while modic changes were observed in 4.2% (2/48) of included patients. The disc below the LIV, L4-5, and L5-S1 were significantly shown to have an increasing trend of Pfirmann grade. The preoperative thoracic kyphosis was significantly lower in the DD group (22.0°) than in the non-DD group (31.4°) (P = 0.025) and negatively correlated with DD (r = -0.482, P = 0.018). The Pfirrmann grade of L5-S1 showed a high level of correlation with DD (r = 0.604, P < 0.001). CONCLUSIONS:The degenerative change at the disc below the LIV, L4-5, and L5-S1 levels was observed following PSI and RD with DVR. Thoracic hypokyphosis may negatively influence intervertebral discs in AIS patients required for deformity correction. Therefore, restoration of thoracic kyphosis is important to prevent long-term DD in AIS.