Spinal balance and lumbar curve stability after selective thoracic fusion in idiopathic scoliosis
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Spinal balance and lumbar curve stability after selective thoracic fusion in idiopathic scoliosis Aaron Gebrelul1 · Ann Marie Karam2 · Kiley Poppino3 · Chan‑Hee Jo3 · B. Stephens Richards1,3 Received: 20 April 2020 / Accepted: 10 October 2020 © Scoliosis Research Society 2020
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 allpedicle 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. Keywords Selective thoracic fusion · Balance · Pedicle screws
Introduction The development of pedicle screw fixation refined correction of pediatric spinal deformity with its superior ability to assist in derotation and translation of the spine. Despite this, the goals of operative treatment have remained constant: (1) correct the deformity and halt progression, (2) preserve as many motion segments as possible, and (3) maintain a balanced spine in both coronal and sagittal planes [1].
* B. Stephens Richards [email protected] 1
University of Texas-Southwestern, Dallas, TX, USA
2
Texas A&M College of Medicine, Bryan, TX, USA
3
Texas Scottish Rite Hospital for Children, Dallas, TX, USA
However, in patients with double curve patterns (thoracic and lumbar), controversy persists regarding the appropriate surgical treatment. Is it better to selectively fuse only the thoracic component knowing this results in less overall correction of the
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