This narrative review examines the decision-making process for selecting upper and lower instrumented vertebrae in adolescent idiopathic scoliosis surgery, synthesizing classification systems, published algorithms, and the authors' own institutional approach to navigating the trade-offs between curve correction, motion preservation, and complication avoidance.
When planning AIS fusion levels, check the clavicle angle first — if the left shoulder is elevated, extend to T2 regardless of PT Cobb angle.
When the triradiate cartilage is open, counsel families about the meaningfully higher risk of adding-on and factor skeletal maturity explicitly into your fusion level and timing decisions.
This narrative review examines the decision-making process for selecting upper and lower instrumented vertebrae in adolescent idiopathic scoliosis surgery, synthesizing classification systems, published algorithms, and the authors' own institutional approach to navigating the trade-offs between curve correction, motion preservation, and complication avoidance.
When planning AIS fusion levels, check the clavicle angle first — if the left shoulder is elevated, extend to T2 regardless of PT Cobb angle.
When the triradiate cartilage is open, counsel families about the meaningfully higher risk of adding-on and factor skeletal maturity explicitly into your fusion level and timing decisions.