Study design:

Prospective cohort.

Objective:

To determine if distal spinal fusion level is associated with postoperative sport participation following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Summary of background data:

The concept of “saving a level” during PSF for AIS refers to minimizing distal extent of lumbar fusion to theoretically allow for increased postoperative spinal mobility and more predictable return to athletic activity, as well as minimizing the risk of degenerative disc disease. There are few prospective studies evaluating the correlation between distal fusion level and timing of return to sports.

Materials and methods:

Adolescent patients undergoing PSF for AIS between 2009 and 2019 were approached at their pre-surgical visit to participate in this prospective study. Participants were followed for a minimum of two years following surgery. Sports participation (classified by sport type and level of competitiveness) and radiographic data were collected at the initial visit. At each post-operative visit, it was noted whether subjects returned to the same sport type and level of competitiveness.

Results:

After an a priori power calculation was performed, a total of 106 participants were included in the analysis with a mean age of 14±2 years. Distal fusion levels ranged from T11-L4. There was no significant association between distal fusion level and return to the same level of sport participation (P=0.167). 93% of participants returned to sports with no significant differences by distal fusion level (P=0.081). Distal fusion level demonstrated no difference in return to preoperative sport (P=0.486) or return to the same type of sport (P=0.247).

Conclusion:

This study found no association between distal fusion level and postoperative sport participation. Even though many patients may elect to change sports, nearly all patients returned to sports, and the majority of patients return to the same level of sports competition or higher following PSF for AIS.