Principles of Level Selection for Instrumentation in Adult Thoracolumbar Spinal Deformity Surgery: Guidelines for Treatment

➢ For primarily scoliotic deformities, the principles of the modular Lenke classification for adult idiopathic scoliosis can be used to guide level selection.➢ For hyperkyphotic deformities, the upper end vertebra is a suitable upper instrumented vertebra. The sagittal stable vertebra or the first lordotic vertebra is appropriate for the lower instrumented vertebra when fusion to the sacrum is not required.➢ Pelvic fixation can be considered in cases of sagittal and coronal malalignment when ≥4 levels of fusion to the sacrum are planned, L3 to L5 3-column osteotomies are planned, the patient has osteoporosis, or significant disc degeneration or stenosis exists at L5 to S1.

Published by The Journal of bone and joint surgery. American volume, 2025. The guideline itself is at the source linked here.

doi.org/10.2106/JBJS.24.00910