Impact of the Choice of the Distal Vertebral in the Surgery of the Thoracic Adolescent Idiopathic Scoliosis
Impact of the Choice of the Distal Vertebral in the Surgery of the Thoracic Adolescent Idiopathic Scoliosis
The problem of choosing the supporting vertebra was the subject of several studies. They do
 not suggest as regards the techniques that are not currently used or with insufficient
 setback.

 The need to have a sufficient number of files with a minimum decline of 5 years for proposing
 a multicenter study that will be conducted within the framework of the Scoliosis Research
 Group (SRG) and will result in a roundtable at the next congress GES in March 2015. the GES
 gathers most of the teams that support this pathology.
Idiopathic scoliosis is a deformity in three planes of space the child's spine and scalable
 teenager with growth. In adults is causing severe deformities of respiratory failure
 responsible and disabling back pain. Scoliosis is most often idiopathic without cause found
 that the genetic origin is being identified. It is detected by the school doctor, the doctor
 or pediatrician. The management is based primarily on monitoring small angle discoveries
 scoliosis and the orthopedic treatment of progressive scoliosis by the specialized services
 of pediatric orthopedics or rehabilitation as recommended by the HAS (February 2008).
 Surgical treatment is reserved for the orthopedic treatment failures or advanced scoliosis
 discovered too late.

 The goal of surgery is to reduce as much as possible distortion in the three planes of space
 and avoid the progression of the deformity in adulthood. Its principle is to correct the
 deformity using instrumentation and maintain over time this correction with a bone graft.
 This is commonly called spinal fusion with instrumentation. The instrumentation includes all
 of the vertebral anchors connected to rods.

 Indications are asked in each case most often in adolescence and sometimes in younger
 children and rarely in adulthood. The procedure performed in adolescence allows to benefit
 from a flexible spine still allowing good reduction of the deformation, a lesser neurological
 risk and good consolidation of the bony fusion guarantees a stable income in the long term.

 Among all types of curves, thoracic scoliosis pose the problem of choosing the bends to be
 instrumented. This choice is an essential element for the initial correction and become the
 long-term. It is the result of a compromise between a long instrumentation that orchestrates
 all of the deformation to the detriment of the mobility of the lumbar spine and a shorter
 instrumentation that preserves mobility at the expense perhaps of a smaller reduction. These
 short instrumentations called selective thoracic instrumentation, the choice of the support
 or lower vertebra vertebra of instrumentation is an unsolved problem and is the subject of
 this work.

 The immediate results of the posterior vertebral arthrodesis are assessed by the correction
 of the deformity in three planes of space: measuring the angle of the curvature in the
 coronal plane, analyzing the return of a physiological kyphosis in sagittal plane and
 correction of the vertebral rotation in the horizontal plane. The results for medium and long
 term are assessed by analyzing the maintenance of correction of the deformity and the
 evolution of the above spine and above underlying arthrodesis. This is appreciated by the
 coronal and sagittal balance, changing the supporting vertebra and the first non-instrumented
 vertebra and evolution spine underlying uninstrumented.

 The problem of choosing the supporting vertebra was the subject of several studies. They do
 not suggest as regards the techniques that are not currently used or with insufficient
 setback.

 The need to have a sufficient number of files with a minimum decline of 5 years for proposing
 a multicenter study that will be conducted within the framework of the Scoliosis Research
 Group (SRG) and will result in a roundtable at the next congress GES in March 2015. the GES
 gathers most of the teams that support this pathology.
Inclusion Criteria:

 -  Thoracic idiopathic scoliosis (Lenke 1 or 2) of the child in puberty and adolescent
 surgery for posterior spinal fusion with instrumentation with a minimum decline of 5
 years.

 -  Thoracic scoliosis Lenke 1 or 2.

 -  Affiliates or beneficiaries of a social security scheme

 -  Initial medical examination.

 Exclusion Criteria:

 -  Scoliosis adult scoliosis and whose age at the time of the transaction is less than 10
 years.

 -  Double major scoliosis (Lenke 3 or 4)

 -  Scoliosis thoracolumbar or lumbar (Lenke 5 or 6).

 -  Non-idiopathic scoliosis.

 -  Opposition by the patient or legal guardian with the use of pre- and postoperative
 data