Critical Observations of the Results in the Operative Treatment of Scoliosis

Lackum, William H. Von; Miller, J P

doi:10.2106/00004623-194931010-00010

Cited by 22 publications

(5 citation statements)

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“…A report by Thompson et al 12 discussed the potential for transmitting torque to the lumbar spine through derotation of the thoracic spine. The theoretical concern is that derotation potentially transmits forces to the lumbar spine, aggravating torsional deformity of the lumbar spine, 1,[12][13][14][15] and induces deformity in the coronal and sagittal planes, thereby reducing the lumbar curve's ability to compensate for thoracic curve correction. Thompson et al 12 recommended that derotation should be avoided in instrumentation of major thoracic curve.…”

Section: Discussionmentioning

confidence: 99%

Broader Curve Criteria for Selective Thoracic Fusion

Chang

Leng

Zhao

et al. 2011

Spine

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Section: Discussionmentioning

confidence: 99%

Broader Curve Criteria for Selective Thoracic Fusion

Chang

Leng

Zhao

et al. 2011

Spine

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“…Although spontaneous lumbar curve correction occurs consistently following a selective thoracic spinal fusion, the degree of correction is somewhat unpredictable. Previous studies have shown that over correction of the thoracic curve is related to progression of the lumbar curve below a selective thoracic fusion [42,43] due to lack of compensatory lumbar curve correction [30,[44][45][46][47][48][49]. It has been hypothesized that the unfused lumbar compensatory curve cannot compensate for excessive correction of the main thoracic curve and this therefore results in coronal decompensation [8,50,51].…”

Section: The Amount Of Correction For Selective Thoracic Fusionmentioning

confidence: 99%

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Fischer

Kim

2011

Eur Spine J

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Selective fusion of thoracic and thoracolumbar/ lumbar curves in adolescent idiopathic scoliosis is a concept critically debated in the literature. While some surgeons strongly believe that a more rigid and straighter spine provides predictably excellent outcomes, some surgeons recommend a mobile and less straight spine. This topic is a crucial part of surgical treatment of idiopathic scoliosis, particularly in young patients who will deal with the stress of the fusion mass at the proximal and distal junctions over many years. This study will review the literature on various aspects of selective fusion.

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“…7,8 Recent interest in determining risk factors for postoperative decompensation after STF has led to research attempting to elucidate criteria for predicting the optimal surgical strategy. Factors such as proper selection of the LIV, 1,3,4,24,29,31,37,[41][42][43] the main thoracic to thoracolumbar/lumbar (MT:TL/L) ratio, 25,28,34 thoracic "overcorrection," 5,6,12,13,16,17,19,25,45 and surgical approach have been correlated with risk of postoperative decompensation. Despite guidelines for performing STF, NSTF is still commonly performed, with one study showing only 49% of patients with Lenke 1C curves being treated with an STF.…”

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Selective versus nonselective thoracic fusion in Lenke 1C curves: a meta-analysis of baseline characteristics and postoperative outcomes

Boniello¹,

Hasan²,

Sun³

et al. 2015

SPI

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OBJECT Lenke 1C curves are challenging to manage surgically due to the structural thoracic deformity and nonstructural lumbar curve. Selective thoracic fusion (STF) is considered the standard of care because it preserves motion of the lumbar segment, yet nonselective STF (NSTF) remains prevalent. This study aims to identify baseline patient characteristics that drive treatment and to compare postoperative outcomes for both procedures. METHODS Studies that compared baseline and postoperative demographic data, health-related quality of life (HRQL) questionnaires, and radiographic parameters of patients with Lenke 1C curves undergoing STF or NSTF were identified for meta-analysis. The effect measure is expressed as a mean difference (MD) with 95% CI. A positive MD signifies a greater STF value, or a mean increase within the group. RESULTS One prospective and 6 retrospective case-control studies with sample size of 488 patients (344 STF and 144 NSTF) were identified. Baseline age, sex, and HRQLs were equivalent, except for better scores in the STF group for the Scoliosis Appearance Questionnaire (SAQ): Unrelated to Deformity item (3.47 vs 3.88, p = 0.01) and the Spine Research Society questionnaire, Item 22: Pain (4.13 vs 3.92, p = 0.04). Radiographic findings were significantly worse in NSTF, as measured by the thoracolumbar/lumbar (TL/L) Cobb angle (MD: −4.29°, p < 0.01) and TL/L apical vertebral translation (AVT) (MD: −6.08, p < 0.01). Radiographic findings significantly improved in STF, as measured in the main thoracic (MT) Cobb angle (MD: −27.78°, p < 0.01), TL/L Cobb angle (MD: −16.24°, p < 0.01), MT:TL/L Cobb ratio (MD: −0.21, p < 0.01), coronal balance (MD: 0.47, p = 0.02), and thoracic kyphosis (MD: 7.87°, p < 0.01); and in NSTF in proximal thoracic (PT) Cobb angle (24° vs 14.1°, p < 0.01), MT Cobb angle (53.5° vs 20.5°, p < 0.01), and TL/L Cobb angle (41.6° vs 16.6°, p < 0.01). Postoperative TL/L Cobb angle (23.1° vs 16.6°, p < 0.01) was significantly higher in STF; but PT Cobb angle, MT Cobb angle, and MT:TL/L Cobb ratio are equivalent. CONCLUSIONS Patients with larger lumbar compensatory curves displaying a larger degree of coronal translation, as measured by the TL/L AVT, are more likely to undergo an NSTF. Contrary to established guidelines, larger MT curve magnitudes and MT:TL/L Cobb angle ratios have not been found to influence the decision to pursue a selective thoracic fusion. Although overall both STF and NSTF groups are found to have effective postoperative coronal balance, the STF group has only modest improvements in the lumbar curve position as determined by a relatively unchanged TL/L AVT. Furthermore, surgeons may prefer NSTF in patients who may have a worse overall perception of their spinal deformity as measured by HRQL measures of pain and desire for appearance change.

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Critical Observations of the Results in the Operative Treatment of Scoliosis

Cited by 22 publications

References 0 publications

Broader Curve Criteria for Selective Thoracic Fusion

Broader Curve Criteria for Selective Thoracic Fusion

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Selective versus nonselective thoracic fusion in Lenke 1C curves: a meta-analysis of baseline characteristics and postoperative outcomes

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