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

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Abstract

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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  1. 622 West 168th Street, PH11-1130, New York, NY, 10032, USA

    Charla R. Fischer & Yongjung Kim

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Appendix: Case presentation

Appendix: Case presentation

Case 1

N.P. is a 17-year-old female with idiopathic scoliosis. Pre-operative standing AP radiograph showed a right thoracic curve of 56° and a left thoracolumbar curve of 52° that bent down to 4° on side-bending films. The thoracic apical vertebral rotation was 2 and the lumbar apical vertebral rotation was 2. The thoracic apical vertebral translation was 37 mm and the lumbar apical vertebral translation was 32 mm. Pre-operative standing lateral radiograph showed thoracic kyphosis at T5–T12 7° and lumbar lordosis T12–S1 at 80°. Scoliometer measurement showed a thoracic angle of 14° and lumbar angle of 5°. She also has an L5/S1 grade 2 spondylolisthesis. She underwent selective thoracic fusion from T4–T11 and postoperative thoracic curve of 35° and lumbar curve of 29° (Fig. 2).

Fig. 2
figure 2

Selective thoracic fusion for Lenke 1CN curve

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Case 2

T.F. is a 13-year-old boy with an idiopathic scoliosis. Pre-operative standing AP radiograph showed a right thoracic curve of 47° and a left thoracolumbar curve of 80°. The lumbar apical vertebral rotation at T13 was 40° and thoracic apical vertebral rotation at T7 was 5°, according to Perdriolle. The thoracic apical vertebral translation was 18 mm and the lumbar apical vertebral translation was 77 mm. The C7 plumb line was 44 mm toward the left side. Pre-operative standing lateral radiograph showed thoracic kyphosis at T5–T12 of 3°, thoracolumbar kyphosis at T10–L2 of 23°, and lumbar lordosis at T12–S1 of 42°. The left side bender of the thoracolumbar curve was 58° and the right side bender was 22°. He also had a left-side only synostosis of L5–S1. His curve is a 6C according to the Lenke classification system. He underwent posterior osteotomy at L5–S1 and selective posterior thoracolumbar instrumentation and fusion at T10–L3 and presented at 12 months follow-up with satisfactory frontal and sagittal spinal alignment (Fig. 3).

Fig. 3
figure 3

Selective thoracolumbar fusion for Lenke 6C curve

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Fischer, C.R., Kim, Y. Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy. Eur Spine J 20, 1048–1057 (2011). https://doi.org/10.1007/s00586-011-1730-9

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