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Comparison of Typical Thoracic Curves and Atypical Thoracic Curves Within the Lenke 1 Classification

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Abstract

Study Design

Retrospective study.

Objectives

To examine the characteristics of Lenke type 1 curves based on the level of the apical vertebra.

Summary of Background Data

The Lenke classification is the most used system for adolescent idiopathic scoliosis, with approximately 50% of the curves falling into the Lenke 1 curve type category.

Methods

A total of 611 Lenke 1 curves in a prospectively collected multicenter adolescent idiopathic scoliosis study were analyzed. Minimum follow-up was ≥ 2 years. Curves were subdivided into 3 groups according to their apex: the typical Lenke 1 curve group included apices from T7/8 to T10 (511 patients), the proximal group included apices from T4 to T7 (45 patients), and the distal group included apices from T10/11 to T11/12 (50 patients). Preoperative and postoperative radiographic and clinical outcomes were compared among the 3 groups.

Results

The proximal and distal groups included significantly more left thoracic curves (proximal: 29%; typical: 1.8%; distal: 19%; p <.01). Flexibility of the main thoracic curve was significantly different among the 3 groups (proximal: 32% ± 17%; typical: 46% ± 18%; distal: 57% ± 18%; p <.001). The distal group included significantly more “A” lumbar modifiers (proximal: 29%; typical: 53%; distal: 96%; p <.01) and had curves characteristics similar to King type 4 curves (L4 tilted to the right: Lenke 1AR). The average lowest instrumented vertebra was significantly lower in the distal group (proximal: T12; typical: L1; distal: L2; p <.01). The proximal group had significantly greater thoracic kyphosis (proximal: 30° ± 18°; typical: 20° ± 13°, distal: 20° ± 10°; p !.001) and more fusion segments (proximal: 10; typical: 9; distal: 9; p <.03).

Conclusions

Curves categorized as Lenke 1 curves were less homogeneous than expected. Using only the Lenke type 1 designation to define a study population may introduce unintended bias to the study design.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Rady Children’s Hospital, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Takahito Fujimori MD, Tracey P. Bastrom MA, Carrie E. Bartley MA & Peter O. Newton MD

  2. Department of Orthopedic Surgery, Sumitomo Hospital, 5-3-20 Nakanoshima, Kita Ward, Osaka, Osaka Prefecture, 530-0005, Japan

    Takahito Fujimori MD

Authors
  1. Takahito Fujimori MD
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  2. Tracey P. Bastrom MA
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  3. Carrie E. Bartley MA
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  4. Peter O. Newton MD
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Consortia

Harms Study Group

Corresponding author

Correspondence to Peter O. Newton MD.

Additional information

Author disclosures: TF (none); TPB (grants from Setting Scoliosis Straight Foundation); CEB (grants from Setting Scoliosis Straight Foundation); PON (grant from Setting Scoliosis Straight Foundation; consulting fee/honorarium from DePuy Spine; support for travel to meetings from DePuy Spine; board membership with POSNA, Harms Study Group Foundation, Scoliosis Research Society, Children’s Specialist Foundation; consultancy for DePuy Spine, Stanford University; employment with Children’s Specialists of San Diego; expert testimony for NorCal, law firm Carroll, Kelly, Trotter, Franzen, and McKenna, law firm Smith, Haughey, Rice, and Roegge; grants from National Institutes of Health (Grant No: R21AR049587), Orthopaedic Research and Education Foundation, POS-NA, SRS, Harms Study Group Foundation, DePuy Synthes Spine, Axial Biotech, Biospace/Med/EOS Imaging; payment for lectures including service on speakers bureaus from DePuy Spine, patents from DePuy Synthes Spine; royalties from DePuy Synthes Spine, Thieme Publishing; payment for development of educational presentations from DePuy Synthes Spine; stock/stock options from Nuvasive); HSG (grants from Setting Scoliosis Straight Foundation).

This study was supported in part by a research grant from Depuy Spine to the Setting Scoliosis Straight Foundation and a grant-in-aid from the Yamada Science Foundation.

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Fujimori, T., Bastrom, T.P., Bartley, C.E. et al. Comparison of Typical Thoracic Curves and Atypical Thoracic Curves Within the Lenke 1 Classification. Spine Deform 2, 308–315 (2014). https://doi.org/10.1016/j.jspd.2014.03.009

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  • DOI: https://doi.org/10.1016/j.jspd.2014.03.009

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