Radiographic evaluation of posterior selective thoracolumbar or lumbar fusion for moderate Lenke 5C curves

Abstract

IntroductionPosterior selective thoracolumbar or lumbar (TL/L) fusion with pedicle screw constructs for adolescent idiopathic scoliosis (AIS) has been studied in a few researches. However, few studies have discussed the indication for selective TL/L fusion and the behaviors of its adjacent disc angle. The present study aims to discuss the indication for posterior selective TL/L fusion and the behavior of the adjacent disc angle.Methods45 consecutive cases of AIS undergoing posterior selective TL/L fusion were retrospectively evaluated, with an average follow-up of 36 months. Radiographs were reviewed to determine the coronal curve magnitude and the sagittal alignment preoperatively, postoperatively and at final follow-up. Thoracic curves in groups A had a correction loss of more than 5°, while thoracic curves in group B had a correction loss of not more than 5°.ResultsThe coronal curve magnitude of the TL/L curve averaged 44° preoperatively and it was corrected to 6° immediately with a correction rate of 84.8 %. At final follow-up it was 9° with a correction loss of 3°. The minor thoracic curve was 26° preoperatively, and the convex side bending curve magnitude averaged 8° with a flexibility of 72.7 %. It was corrected to 13° immediately with a spontaneous correction of 48.5 %. At final follow-up it was 14° with a correction loss of 1°. UIVA decreased from 4° to 2° after surgery, and it was 2° at final follow-up. LIVA decreased from 7° to 4° after surgery, and it was 5° at final follow-up. Maximal correction of TL/L curves in group A is significantly less than that in group B. 1 patient received revision surgery to fuse the progressive thoracic curve.ConclusionPosterior selective TL/L fusion with pedicle screw constructs allows for spontaneous thoracic correction and maintains coronal and sagittal balance during the follow-up. Maximal correction instead of undercorrection was recommended for moderate Lenke 5C curves. Disc wedging could be improved after surgery and well maintained during the follow-up.

Single-bundle versus double-bundle autologous anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials at 5-year minimum follow-up

“…All included studies [ 33 – 37 ] failed to conduct the blinding therapists regarding DB or SB technique, and thus these were rated as having a high risk of performance bias. The studies by Beyaz et al [ 34 ] and Zaffagnini et al [ 37 ] did not describe the blinding of outcome assessment, and thus these were rated as an unknown risk for detection bias. One study [ 34 ] lost more than 20% of enrolled patients during follow-up and was regarded as having a high risk of attribution bias.…”

“…The studies by Beyaz et al [ 34 ] and Zaffagnini et al [ 37 ] did not describe the blinding of outcome assessment, and thus these were rated as an unknown risk for detection bias. One study [ 34 ] lost more than 20% of enrolled patients during follow-up and was regarded as having a high risk of attribution bias. All included studies [ 33 – 37 ] offered insufficient information to judge selective outcome reporting, and thus these were rated as having an unknown risk of reporting bias.…”

“…All included studies [ 33 – 37 ] offered insufficient information to judge selective outcome reporting, and thus these were rated as having an unknown risk of reporting bias. One study [ 34 ] included only male patients and one study [ 37 ] used hamstring for DB technique ACL reconstruction and used bone-patellar tendon-bone for SB technique ACL reconstruction, and thus these were rated as having a high risk of potential other bias.

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“…In our study, the DB technique had no great difference with the SB technique in OA changes. Tunnel widening may lead to the inability of the implanted graft, long-term joint laxity, and difficulty in revision surgery [ 34 , 45 ]. However, only one included RCT touched upon tunnel widening, and thus it was not suitable for conducting a meta-analysis.…”

Treatment of distal tibia fractures: plating versus intramedullary nailing

“…However, significant complication rates are higher with plating especially when used in the treatment of open tibial fractures. [17][18][19][20][21][22][23][24][25][26][27] In our study three (9%) patients from nailing group had malalignment whereas one case in plating group had malunion. The malunion was not clinically significant and hence no additional surgery was done.…”