Lenke 5C Curves in Adolescent Idiopathic Scoliosis: Anterior vs Posterior Selective Fusion

Abstract BACKGROUND: The optimal treatment of Lenke 5C curves in adolescent idiopathic scoliosis is still unclear. OBJECTIVE: To compare the outcomes and the spontaneous correction behavior between anterior and posterior selective fusion techniques in a large case series. METHODS: Demographic and surgical data for patients with Lenke 5C curves treated with anterior or posterior fusion were collected from July 2002 to September 2011. Clinical assessment and radiographic parameters were compared preoperatively and postoperatively and at a minimum of 2 years of follow-up. RESULTS: Fifty-three Lenke 5C adolescent idiopathic scoliosis cases with an average follow-up of 4 years (range, 2-9.6 years) were included. The clinical scores were similar between the 2 groups. Postoperative major thoracic curvature changes were similar. The minor thoracic curve demonstrated a higher spontaneous correction rate in the posterior group. At follow-up, the minor thoracic curve showed a greater loss of correction in the posterior group, and finally both groups were comparable. Surgical time, intraoperative blood loss, and complications were comparable. A total of 5 patients had a final thoracic curve larger than the preoperative degrees. CONCLUSION: Selective fusion of the major thoracolumbar/lumbar curve in Lenke 5C adolescent idiopathic scoliosis can be achieved by anterior and posterior techniques. The spontaneous correction of the unfused thoracic curve was comparable after an average of 4 years follow-up.

Download Full-text

Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

European Spine Journal ◽

10.1007/s00586-021-06897-y ◽

2021 ◽

Author(s):

Cesare Faldini ◽

Francesca Barile ◽

Fabrizio Perna ◽

Stefano Pasini ◽

Michele Fiore ◽

...

Keyword(s):

Surgical Technique ◽

Idiopathic Scoliosis ◽

Case Series ◽

Deformity Correction ◽

Pedicle Screws ◽

Mechanical Complication ◽

Non Union ◽

Implant Retention ◽

Surgical Data

Abstract Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

Download Full-text

Predicted final spinal height in patients with adolescent idiopathic scoliosis can be achieved by surgery regardless of maturity status

The Bone & Joint Journal ◽

10.1302/0301-620x.100b10.bjj-2017-1540.r2 ◽

2018 ◽

Vol 100-B (10) ◽

pp. 1372-1376 ◽

Cited By ~ 4

Author(s):

H. Bao ◽

Z. Liu ◽

M. Bao ◽

Z. Zhu ◽

P. Yan ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Growth Restriction ◽

Fusion Surgery ◽

Group 4 ◽

Selective Fusion ◽

Group 3 ◽

Group 2 ◽

Group 1

Aims The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. Patients and Methods The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOSf) and height of pelvis at follow-up (HOPf) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOPf. One-way analysis of variance (ANOVA) was performed for statistical analysis. Results Of the 152 patients, there were 32 patients in Group 1, 27 patients in Group 2, 48 patients in Group 3, and 45 patients in Group 4. Significantly greater HOSf was observed in Group 3 compared with Group 1 (p = 0.03) and in Group 4 compared with Group 2 (p = 0.02), with similar HOPf (p = 0.75 and p = 0.83, respectively), suggesting that patients who undergo surgery at Risser grade of 0 to 1 have a shorter spinal height at follow-up than those who have surgery at Risser 4 to 5. HOSf was similar to pHOS in both Group 1 and Group 2 (p = 0.62 and p = 0.45, respectively), indicating that undergoing surgery at Risser 0 to 1 does not necessarily affect final spinal height. Conclusion This study shows that fusion surgery at Risser 0 may result in growth restriction unlike fusion surgery at Risser 3 to 4. Despite such growth restriction, AIS patients could reach their predicted or ‘normal’ spinal height after surgery regardless of baseline maturity status due to the longer baseline spinal length in AIS patients and the remaining growth potential at the non-fusion levels. Cite this article: Bone Joint J 2018;100-B:1372–6.

Download Full-text

Comparison of 5-year outcomes between pedicle screw and hybrid constructs in adolescent idiopathic scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2012.6.spine1215 ◽

2012 ◽

Vol 17 (3) ◽

pp. 212-219 ◽

Cited By ~ 10

Author(s):

Steven W. Hwang ◽

Amer F. Samdani ◽

Ben Wormser ◽

Hari Amin ◽

Jeff S. Kimball ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Thoracic Curve ◽

Patients Âgés ◽

Thoracic Curvature ◽

Main Thoracic

Object Pedicle screw fixation has been theorized to provide better correction of scoliotic deformity, but controversy over the benefits of pedicle screw–only constructs remains, and the longer-term impact of pedicle screw fixation as compared with hybrid constructs is unclear. In this study, a retrospective review of a prospectively collected database was conducted to determine the longer-term impact of pedicle screw fixation as compared with hybrid constructs in patients with adolescent idiopathic scoliosis (AIS). Methods The authors retrospectively reviewed a multicenter database of pediatric patients (ages ≤ 18) from 1995 to 2006 and identified 127 patients with Lenke Type 1–4 AIS curves with a minimum 5 years of follow-up. Patients were divided into 2 cohorts based on whether they had undergone pedicle screw fixation or fixation with hybrid constructs. Results The mean main thoracic curvature of 56.1° ± 13.0°, which corrected to 14.9° ± 9.3°, translated into a mean correction of 73% (p < 0.01). The curve was 19.4° ± 10.6° at 2-year follow-up and 20.5° ± 10.4° at 5 years. When comparing preoperative parameters between the groups, differences were noted in the magnitude of the main thoracic curve (p = 0.04), flexibility of the main thoracic curve (p = 0.02), coronal balance (p = 0.04), T2–12 kyphosis (p = 0.02), and sex (p = 0.02). The pedicle screw cohort had fewer spinal segments instrumented (p < 0.01), fewer anterior releases performed (p = 0.02), and fewer thoracoplasties performed (p < 0.01). By 5 years of follow-up, significant differences were apparent between the two cohorts with respect to upper thoracic curvature (p = 0.01), T2–12 (p = 0.02) and T5–12 (p = 0.02) kyphosis, lumbar lordosis (p < 0.01), and sagittal balance (p = 0.01). Conclusions Although some preoperative differences did exist, outcomes were comparable between hybrid and screw constructs at 2 and 5 years. However, hybrid constructs required more concurrent anterior releases and thoracoplasties to achieve similar results.

Download Full-text

Long-Term Follow-up of Posterior Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke 5C Adolescent Idiopathic Scoliosis: An Analysis of 10-Year Outcomes

Global Spine Journal ◽

10.1177/2192568220965566 ◽

2020 ◽

pp. 219256822096556

Author(s):

Kai Chen ◽

Yu Chen ◽

Jie Shao ◽

Junke Zhoutian ◽

Fei Wang ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Clinical Outcomes ◽

Sagittal Plane ◽

Lumbar Fusion ◽

Image Domain ◽

Selective Fusion ◽

Increasing Trend

Study Design: Retrospective study. Objective: The aim of this study was to assess long-term radiographic and clinical outcomes in Lenke 5C adolescent idiopathic scoliosis (AIS) patients after posterior selective fusion. Methods: Lenke 5C AIS patients who underwent posterior selective thoracolumbar/lumbar (TL/L) fusion in our hospital from January 2007 to January 2010 were recruited. Radiographic parameters were measured preoperatively and at the 3-month, 1-year, 2-year, 5-year, and 10-year follow-ups. The SRS-22 (Scoliosis Research Society) questionnaire was used to assess the clinical outcomes. Results: We included 37 patients who underwent posterior selective TL/L fusion surgery in our study, and the mean follow-up time was 11.26 ± 0.85 years. The average preoperative Cobb angles of the thoracic and TL/L curves were 24.0 ± 9.0° and 45.4 ± 6.3°, respectively, which were corrected to 12.2° and 12.4° at the 3-month follow-up postoperatively, with correction losses of 2.2° and 1.5° at the 10-year follow-up. In the sagittal plane, the degree of thoracic kyphosis (TK) gradually increased over the follow-up period. The proximal junctional angle (PJA) also gradually increased from 6.7 ± 4.6 to 13.7 ± 5.6 during the follow-up period. For the clinical outcomes, correction surgery improved the SRS-22 scores in each domain, especially in the self-image domain. Conclusions: Posterior selective TL/L fusion can effectively correct spinal deformities, leading to stable outcomes for 10 years postoperatively. During the follow-up period, the degree of TK presented an increasing trend that remained almost constant after the 1-year follow-up. Moreover, the variation in the PJA was highly significant in the postoperative period, and it showed an increasing trend until the 2-year follow-up.

Download Full-text

Characteristics analysis of segmental and regional lumbar spontaneous compensation post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04821-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kai Chen ◽

Xiao Zhai ◽

Tianjunke Zhou ◽

Yu Deng ◽

Beichen Zhang ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Demographic Data ◽

Wedge Angle ◽

Lumbar Region ◽

Lumbar Curve ◽

Angle Variation ◽

Spontaneous Correction

Abstract Objective To explore the characteristics of compensation of unfused lumbar region post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis. Background Preserving lumbar mobility in the compensation is significant in controlling pain and maintaining its functions. The spontaneous correction of the distal unfused lumbar curve after STF has been widely reported, but previous study has not concentrated on the characteristics of compensation of unfused lumbar region post thoracic fusion. Method A total of 51 Lenke 1 and2 AIS patients were included, whose lowest instrumented vertebrae was L1 from January 2013 to December 2019. For further analysis, demographic data and coronal radiographic films were collected before surgery, at immediate erect postoperatively and final follow-up. The wedge angles of each unfused distal lumbar segments were measured, and the variations in each disc segment were calculated at the immediate postoperative review and final follow-up. Meanwhile, the unfused lumbar curve was divided into upper and lower parts, and we calculated their curve angles and compensations. Results The current study enrolled 41 females (80.4%) and 10 males (19.6%). Thirty-six patients were Lenke type 1, while 15 patients were Lenke type 2. The average main thoracic Cobb angle and thoracolumbar/lumbar Cobb angle were 44.1 ± 7.7°and 24.1 ± 9.3°, preoperatively. At the final follow-up, the disc wedge angle variation of L1/2, L2/3, L3/4, L4/5 and L5/S1 was 3.84 ± 5.96°, 3.09 ± 4.54°, 2.30 ± 4.53°, − 0.12 ± 3.89° and − 1.36 ± 2.80°, respectively. The compensation of upper and lower coronal lumbar curves at final follow-up were 9.22 ± 10.39° and − 1.49 ± 5.14°, respectively. Conclusion When choosing L1 as the lowest instrumented vertebrae, the distal unfused lumbar segments’ compensation showed a decreasing trend from the proximal end to the distal end. The adjacent L1/2 and L2/3 discs significantly contributed to this compensation.

Download Full-text

Predictability of spontaneous thoracic curve correction after anterior thoracolumbar correction and fusion in adolescent idiopathic scoliosis. A retrospective study on a consecutive series of 29 patients with a minimum follow-up of 2 years

The Spine Journal ◽

10.1016/j.spinee.2013.06.013 ◽

2015 ◽

Vol 15 (5) ◽

pp. 966-970 ◽

Cited By ~ 11

Author(s):

Geertje C. Huitema ◽

Rob C. Jansen ◽

André van Ooij ◽

Ilona M. Punt ◽

Lodewijk W. van Rhijn

Keyword(s):

Retrospective Study ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Thoracic Curve ◽

Consecutive Series ◽

Curve Correction

Download Full-text

Can We Predict the Ultimate Lumbar Curve in Adolescent Idiopathic Scoliosis Patients Undergoing a Selective Fusion with Undercorrection of the Thoracic Curve?

Spine ◽

10.1097/01.brs.0000106488.51299.75 ◽

2004 ◽

Vol 29 (3) ◽

pp. 277-285 ◽

Cited By ~ 53

Author(s):

Matthew B. Dobbs ◽

Lawrence G. Lenke ◽

Tim Walton ◽

Michael Peelle ◽

Greg Della Rocca ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Thoracic Curve ◽

Lumbar Curve ◽

Selective Fusion

Download Full-text

Sagittal spinopelvic changes after posterior spinal fusion in adolescent idiopathic scoliosis

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200155 ◽

2020 ◽

Vol 14 (6) ◽

pp. 544-553

Author(s):

Denver A. Burton ◽

Alexa J. Karkenny ◽

Jacob F. Schulz ◽

Regina Hanstein ◽

Jaime A. Gomez

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Calculated Data ◽

Posterior Spinal Fusion ◽

Vertical Alignment ◽

Level Of Evidence ◽

Selective Fusion ◽

Lowest Instrumented Vertebra ◽

Junctional Kyphosis

Purpose This article examines if longer posterior spinal fusions with instrumentation (PSFI) into the lumbar spine (L3/4) alter spinopelvic parameters compared with selective fusions to T12/L1/L2 in adolescent idiopathic scoliosis (AIS) patients. Methods We analysed radiographs of 84 AIS patients, 58 (69%) females and 26 (31%) males, who underwent PSFI at an mean age of 15 years ± 2.5 years, range 10 years to 21 years, between 1st January 2007 and 31st December 2014. Radiographic parameters were measured pre- and post-operatively at most recent follow-up (range 2 years to 8.2 years): pelvic incidence (PI), lumbar lordosis (LL, L1–S1 and L4–S1), sagittal vertical alignment (SVA), scoliosis angle and proximal junctional kyphosis (PJK). PI–LL was calculated. Data was analysed using t-tests or Wilcoxon rank-sum tests. Results In total, 32 patients underwent a selective fusion with lowest instrumented vertebra (LIV) T12–L2, and 52 patients underwent a fusion with LIV L3–L4. In both groups, scoliosis angle was significantly corrected at follow-up (p < 0.005). Pre-operatively, both groups had similar LL (L1–S1) and PI–LL. Post-operatively, LL increased in the L3–4 fusion group (p < 0.005) but did not change in the selective fusion group (p = 0.116). This change in LL in the L3–4 fusion group affected the post-operative PI–LL (T12–L2 fusion -4.9° versus L3–4 fusion -13.6°, p = 0.002). No differences were seen in PI, SVA or LL L4–S1 between groups. Radiographic PJK occurred in seven of the L3–4 patients with and without PJK (noPJK –8.8° versus PJK –25.8°, p = 0.026). Conclusions In patients who underwent a fusion ending at L3 or L4, LL was increased. This altered the PI–LL relationship, and appeared to increase the risk of PJK. Level of evidence III

Download Full-text

Characteristics analysis of Segmental and Regional Lumbar Spontaneous Compensation Post Selective Thoracic Fusion in Lenke 1 and 2 Adolescent Idiopathic Scoliosis

10.21203/rs.3.rs-676609/v1 ◽

2021 ◽

Author(s):

Kai Chen ◽

Xiao Zhai ◽

Tianjunke Zhou ◽

Yu Deng ◽

Shaofeng Chen ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Demographic Data ◽

Wedge Angle ◽

Lumbar Region ◽

Lumbar Curve ◽

Selective Thoracic Fusion ◽

Spontaneous Correction

Abstract ObjectiveTo explore the characteristics of compensation of unfused lumbar region post selective thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis BackgroundPreserving lumbar mobility in the compensation is significant in controlling pain and maintaining its functions. The spontaneous correction of the distal unfused lumbar curve after STF has been widely reported, but previous study has not concentrated on the characteristics of compensation of unfused lumbar region post selective thoracic fusion.MethodA total of 51 Lenke 1 and2 AIS patients were included, whose lowest instrumented vertebrae was L1 from January 2013 to December 2019. For further analysis, demographic data and coronal radiographic films were collected before surgery, at immediate erect postoperatively and final follow-up. The wedge angles of each unfused distal lumbar segments were measured, and the variations in each disc segment were calculated at the immediate postoperative review and final follow-up. Meanwhile, the unfused lumbar curve was divided into upper and lower parts, and calculated their curve angles and compensations.ResultsThe current study enrolled 41 females (80.4%) and 10 males (19.6%). 36 patients were Lenke type 1, while 15 patients were Lenke type 2. The average main thoracic Cobb angle and thoracolumbar/lumbar Cobb angle were 44.1±7.7°and 24.1±9.3°, preoperatively. At the final follow-up, the disc wedge angle variation of L1/2, L2/3, L3/4, L4/5 and L5/S1 was 3.84±5.96°, 3.09±4.54°, 2.30±4.53°, -0.12±3.89° and -1.36±2.80°, respectively. The compensation of upper and lower coronal lumbar curves at final follow-up were 9.22±10.39° and -1.49±5.14°, respectively.ConclusionWhen choosing L1 as the lowest instrumented vertebrae, the distal unfused lumbar segments' compensation showed a decreasing trend from the proximal end to the distal end. The adjacent L1/2 and L2/3 discs significantly contributed to this compensation.

Download Full-text