Abstract
Purpose
To examine the radiological and clinical outcomes of a single-center case series of selective thoracic fusions (STF) in adolescent idiopathic scoliosis with Lenke C modifier curves, with a long-term follow-up.
Methods
We evaluated at 6 months and 10 years different radiological parameters on both thoracic and lumbar districts: coronal curves, sagittal curves, apical vertebral translation (AVT), and apical vertebral rotation (AVR). The clinical outcome was determined using the SRS 22 score. Data were also analyzed dividing the patients by their Risser and Lenke scores.
Results
In examining 90 patients we reported a radiological benefit from STF on both thoracic and lumbar districts. The corrections in the values of both coronal curves, AVT, and AVR are relevant at 6 months and do not significantly vary at the latest follow-up. Sagittal curves are not relevantly affected at any time point. All the SRS 22 score evaluations showed significant improvement at 6 months, in particular, the self-image analysis. A further improvement was also reported at 10 years, in particular in pain and function scores. At no time point were significant differences retrieved by comparing SRS 22 results as divided by Risser or Lenke grading systems.
Conclusions
STF is an effective treatment option both in clinical and radiographical terms. The results at 10-year follow-up confirm both the stability of the correction and the improvement of the clinical outcome scores. Risser and Lenke grading systems are not relevant variables predictive of clinical efficacy.
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References
Fischer CR, Kim Y (2011) Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy. Eur Spine J. 20(7):1048–1057. doi:10.1007/s00586-011-1730-9
Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Jt Surg Am 83(A(8)):1169–1181
Crawford CH 3rd, Lenke LG, Sucato DJ, Richards BS 3rd, Emans JB, Vitale MG, Erickson MA, Sanders JO (2013) Selective thoracic fusion in Lenke 1C curves: prevalence and criteria. Spine (Phila Pa 1976) 38(16):1380–1385. doi:10.1097/BRS.0b013e3182987360
Boniello AJ, Hasan S, Yang S, Jalai CM, Worley N, Passias PG (2015) Selective versus nonselective thoracic fusion in Lenke 1C curves: a meta-analysis of baseline characteristics and postoperative outcomes. J Neurosurg Spine 23(6):721–730. doi:10.3171/2015.1.SPINE141020
Edwards CC 2nd, Lenke LG, Peelle M, Sides B, Rinella A, Bridwell KH (2004) Selective thoracic fusion for adolescent idiopathic scoliosis with C modifier lumbar curves: 2- to 16-year radiographic and clinical results. Spine (Phila Pa 1976) 29(5):536–546
Chang MS, Bridwell KH, Lenke LG, Cho W, Baldus C, Auerbach JD, Crawford CH 3rd, O’Shaughnessy BA (2010) Predicting the outcome of selective thoracic fusion in false double major lumbar “C” cases with five- to twenty-four-year follow-up. Spine (Phila Pa 1976) 35(24):2128–2133. doi:10.1097/BRS.0b013e3181e5e36e
Chang KW, Chen YY, Leng X, Wu CM, Chen TC, Wang YF, Zhang GZ (2014) Guan-Din method: a novel surgical technique for selective thoracic fusion to maximize the rate of selective thoracic fusion and compensatory correction. Spine (Phila Pa 1976) 39(4):E284–E293. doi:10.1097/BRS.0000000000000111
Risser JC (1958) The iliac apophysis; an invaluable sign in the management of scoliosis. Clin Orthop 11:111–119
Nash CL Jr, Moe JH (1969) A study of vertebral rotation. J Bone Jt Surg Am 51(2):223–229
Asher M, Min Lai S, Burton D, Manna B (2003) The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976) 28(1):63–69
Mok JM, Hu SS (2007) Surgical strategies and choosing levels for spinal deformity: how high, how low, front and back. Neurosurg Clin N Am 18(2):329–337
Lettice JJ, Kula TA, Derby R, Kim BJ, Lee SH, Seo KS (2005) Does the number of levels affect lumbar fusion outcome? Spine (Phila Pa 1976) 30(6):675–681
Moe JH (1958) A critical analysis of methods of fusion for scoliosis; an evaluation in two hundred and sixty-six patients. J Bone Jt Surg Am 40(A(3)):529–554
King HA, Moe JH, Bradford DS, Winter RB (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Jt Surg Am 65(9):1302–1313
Eardley-Harris N, Munn Z, Cundy PJ, Gieroba TJ (2015) The effectiveness of selective thoracic fusion for treating adolescent idiopathic scoliosis: a systematic review protocol. JBI Database Syst Rev Implement Rep 13(11):4–16
Senkoylu A, Luk KD, Wong YW, Cheung KM (2014) Prognosis of spontaneous thoracic curve correction after the selective anterior fusion of thoracolumbar/lumbar (Lenke 5C) curves in idiopathic scoliosis. Spine J (United States) 14(7):1117–1124
Ilharreborde B, Ferrero E, Angelliaume A, Lefèvre Y, Accadbled F, Simon AL, de Gauzy JS, Mazda K (2017) Selective versus hyperselective posterior fusions in Lenke 5 adolescent idiopathic scoliosis: comparison of radiological and clinical outcomes. Eur Spine J. doi:10.1007/s00586-017-5070-2
Skaggs DL, Seehausen DA, Yamaguchi KT, Hah RJ, Wright ML, Bumpass DB, Kim HJ, Andras LM, Vitale MG, Lenke LG (2016) Assessment of lowest instrumented vertebra tilt on radiographic measurements in Lenke “C” modifier curves undergoing selective thoracic fusion in adolescent idiopathic scoliosis. Spine Deform (United States) 4(2):125–130
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Scaramuzzo, L., Giudici, F., Bongetta, D. et al. Thoraco-lumbar selective fusion in adolescent idiopathic scoliosis with Lenke C modifier curves: clinical and radiographic analysis at 10-year follow-up. Eur Spine J 26 (Suppl 4), 514–523 (2017). https://doi.org/10.1007/s00586-017-5152-1
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DOI: https://doi.org/10.1007/s00586-017-5152-1