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Spinal balance and lumbar curve stability after selective thoracic fusion in idiopathic scoliosis

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Abstract

Purpose

Selective thoracic fusion (STF) for double curve patterns in idiopathic scoliosis is an attractive treatment option. However, short-term coronal decompensation and truncal imbalance are known findings. Previous studies with hook constructs showed that eventually balance is achieved via an increase in lumbar curve magnitude, as the lumbosacral obliquity did not change following surgery. Our aim is to investigate patients with idiopathic curves who underwent STF using all-pedicle screw constructs to determine if the uninstrumented lumbar curve and lumbosacral obliquity responded in the same manner as was previously reported with all-hook constructs.

Methods

102 consecutive patients with Lenke 1B, 1C or 3C curves who underwent STF using all-screw constructs at a single institution were included in this study. Radiographic assessment was performed, and patient reported outcomes were obtained. Subgroup analyses were performed based on preoperative thoracic: lumbar curve ratio as well as lumbar curve magnitude.

Results

Overall, the patients showed statistically significant improvement in both trunk shift and L4-pelvis obliquity at final follow-up. The uninstrumented lumbar curves trended toward improvement over time, but did not reach statistical significance (p = 0.107). SRS-30 scores were statistically significantly improved in multiple domains.

Conclusion

Selective thoracic fusion is an excellent treatment option in most double curve patterns. Balance in the coronal plane is predictably achieved at 2-year follow-up. The lumbosacral obliquity improves more with screw technology than was previously found with hook constructs; therefore, the improvement in balance over time does not depend upon an increase in the uninstrumented lumbar curve.

Level of evidence

IV.

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Authors and Affiliations

  1. University of Texas-Southwestern, Dallas, TX, USA

    Aaron Gebrelul & B. Stephens Richards

  2. Texas A&M College of Medicine, Bryan, TX, USA

    Ann Marie Karam

  3. Texas Scottish Rite Hospital for Children, Dallas, TX, USA

    Kiley Poppino, Chan-Hee Jo & B. Stephens Richards

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Contributions

AG: substantial contributions to: conceptualization, methodology, acquisition, formal analysis and investigation, interpretation of the data; drafted the work (including draft one) and revised it critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AMK: substantial contributions to: conceptualization, methodology, acquisition, formal analysis and investigation, interpretation of the data; drafted the work and revised it critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. KP: substantial contributions to: conceptualization, methodology, acquisition, formal analysis and investigation, interpretation of the data; drafted the work and revised it critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. C-HJ: substantial contributions to: conceptualization, methodology, acquisition, formal analysis and investigation, interpretation of the data; drafted the work and revised it critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BSR: substantial contributions to: conceptualization, methodology, acquisition, formal analysis and investigation, interpretation of the data, and overall supervision; drafted the work and revised it critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to B. Stephens Richards.

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Aaron Gebrelul has no conflict of interest. Ann Marie Karam has no conflict of interest. Kiley Poppino has no conflict of interest. Chan-Hee Jo has no conflict of interest. B. Stephens Richards has no conflict of interest.

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The study was approved by the Texas Scottish Rite Hospital Institutional Review Board and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Gebrelul, A., Karam, A.M., Poppino, K. et al. Spinal balance and lumbar curve stability after selective thoracic fusion in idiopathic scoliosis. Spine Deform 9, 471–480 (2021). https://doi.org/10.1007/s43390-020-00229-8

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