Factors Involved in the Decision to Perform a Selective Versus Nonselective Fusion of Lenke 1B and 1C (King-Moe II) Curves in Adolescent Idiopathic Scoliosis

Newton, Peter O.; Faro, Frances D.; Lenke, Lawrence G.; Betz, Randal R.; Clements, David H.; Lowe, Thomas G.; Häher, Thomas R.; Merola, Andrew A.; D’Andrea, Linda; Marks, Michelle; Wenger, Dennis R.

doi:10.1097/01.brs.0000092461.11181.cd

Cited by 92 publications

(38 citation statements)

References 22 publications

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“…This result is contradictory to the recommendations provided by the Lenke classification and thus the Lenke lumbar C modifier was termed a ''rule breaker''. Another study by Newton et al [29] showed that five AIS centers in the United States varied between 6 and 67% for selective thoracic fusions for Lenke 1C curves.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

confidence: 99%

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

Fischer

Kim

2011

Eur Spine J

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“…3,20,38,43 With the evolution of spinal instrumentation and surgical techniques, STF has been shown to provide successful correction of the thoracic curve with spontaneous correction of the uninstrumented lumbar curve to allow for a well-balanced postoperative spinal column; 5,6,23,32,34,36,40,42 however, the risk for coronal decompensation remains a concern. 1,13,14,24,28,29,31,32,43 The decision to include the lumbar compensatory curve by performing a nonselective thoracic fusion (NSTF) may provide a "safer" option in the context of preventing revision surgery for coronal decompensation. 32 However, it must be weighed against the risk of an increased likelihood of back pain and degenerative changes with a more distal fusion into the mid-and lower lumbar spine.…”

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confidence: 99%

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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“…Improving thoracic kyphosis to maintain or improve lumbar lordosis has been recommended by previous authors [2,10,16,19]. Newton et al [17] reported that posterior segmental instrumentation for AIS significantly decreased thoracic kyphosis, which was also correlated to a loss of lumbar lordosis.…”

Section: Discussionmentioning

confidence: 97%

“…Such studies discuss stable and neutral vertebrae, coronal tilt of end vertebrae, selective thoracic fusion, and a variety of additional parameters that can be measured on straight and side bending radiographs [13][14][15][16]. There is a paucity of studies which analyze how to restore appropriate lumbar lordosis.…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for loss of lumbar lordosis in patients who had surgical treatment with segmental instrumentation for adolescent idiopathic scoliosis

et al. 2013

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Purpose Iatrogenic flattening of lumbar lordosis in patients with adolescent idiopathic scoliosis (AIS) was a major downside of first generation instrumentation. Current instrumentation systems allow a three-dimensional scoliosis correction, but flattening of lumbar lordosis remains a significant problem which is associated with decreased healthrelated quality of life. This study sought to identify risk factors for loss of lumbar lordosis in patients who had surgical correction of AIS with the use of segmental instrumentation. Methods Patients were included if they had surgical correction for AIS with segmental pedicle screw instrumentation Lenke type 1 or 2 and if they had a minimum follow-up of 24 months. Two groups were created, based on the average loss of lumbar lordosis. The two groups were then compared and multivariate analysis was performed to identify parameters that correlated to loss of lumbar lordosis. Results Four hundred and seventeen patients were analyzed for this study. The average loss of lumbar lordosis at 24 months follow-up was an increase of 10°lordosis for group 1 and a decrease of 15°for group 2. Risk factors for loss of lumbar lordosis included a high preoperative lumbar lordosis, surgical decrease of thoracic kyphosis, and the particular operating surgeon. The lowest instrumented vertebra or spinopelvic parameters were two of many parameters that did not seem to influence loss of lumbar lordosis. Conclusion This study identified important risk factors for decrease of lumbar lordosis in patients who had surgical treatment for AIS with segmental pedicle screw instrumentation, including a high preoperative lumbar lordosis, surgical decrease of thoracic kyphosis, and factors attributable to a particular operating surgeon that were not quantified in this study.

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Factors Involved in the Decision to Perform a Selective Versus Nonselective Fusion of Lenke 1B and 1C (King-Moe II) Curves in Adolescent Idiopathic Scoliosis

Cited by 92 publications

References 22 publications

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

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

Analysis of risk factors for loss of lumbar lordosis in patients who had surgical treatment with segmental instrumentation for adolescent idiopathic scoliosis

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