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Extensive fusion for Lenke 3C and 6C scoliosis: a two year radiographic follow-up

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Abstract

Purpose

To investigate the correction effectiveness, incidence rate of distal adding on, and post-operative spinal balance in Lenke 3C and 6C AIS treated with extensive fusion using posterior pedicle screw-only constructs.

Methods

We reviewed all AIS cases surgically treated in our institution between 2002 and 2008. The inclusion criteria were as follows: (1) Lenke 3C or 6C scoliosis patients who were treated with extensive fusion using posterior pedicle screw-only constructs; (2) minimum two year radiographic follow-up; (3) the lowest instrumented vertebra (LIV) ended at L2, L3 or L4 level. All image data were available in our picture archiving and communication systems (PACSs) , and all radiographic measurements were performed. Standing anteroposterior (AP) and lateral digital radiographs were reviewed at four different time points (pre-op, post-op, three months, and two years). In each standing AP radiograph, CSVL (center sacral vertical line, the vertical line bisecting the proximal sacrum) was first drawn, followed by measurement of the translation (deviation from the CSVL) of some key vertebrae, such as the lowest instrumented vertebra (LIV), LIV + 1 (the first vertebra below LIV), lumbar apical vertebra, thoracic apical vertebra and T1, enabling depiction of how translation of different parts of the spine changes over time. Additionally, the Cobb angles of major thoracic and lumbar curves were measured at the different time points and the correction rate was calculated.

Results

Of the 278 patients reviewed, 25 met the inclusion criteria. Immediately after surgery, satisfactory corrections were achieved from the perspective of not only Cobb angle but also vertebral translation. And the corrections were well retained in the following two years. The incidence rate of distal adding-on was low in this group of patients. In the course of two years following surgery, only six patients had an increase of greater than 5 mm in LIV + 1 translation, and among which only two patients had greater than 10 mm. Regarding global balance, overall, it neither improved nor deteriorated after extensive fusion. Furthermore, trunk shift was found in only three patients at two year follow-up.

Conclusions

In Lenke 3C and 6C scoliosis, extensive fusion can produce satisfactory corrections from the perspectives of both Cobb angle and vertebral translation and rarely causes significant distal adding-on, global imbalance or trunk shift.

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References

  1. Newton PO, Faro FD, Lenke LG et al (2003) 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. Spine 28(20):S217–S223

    Article  PubMed  Google Scholar 

  2. Newton PO, Upasani VV, Bastrom TP et al (2009) The deformity-flexibility quotient predicts both patient satisfaction and surgeon preference in the treatment of Lenke 1B or 1C curves for adolescent idiopathic scoliosis. Spine 34(10):1032–1039

    Article  PubMed  Google Scholar 

  3. Tao F, Shi Z, Xie Y et al (2011) Determination of lowest instrumented vertebra by the location of apical vertebra in Lenke type 1 adolescent idiopathic scoliosis. Int Orthop 35(4):561–567

    Article  PubMed  Google Scholar 

  4. Liu Y, Li M, Zhu XD et al (2009) Retrospective analysis of anterior correction and fusion for adolescent idiopathic thoracolumbar/lumbar scoliosis: the relationship between preserving mobile segments and trunk balance. Int Orthop 33:191–196

    Article  PubMed  Google Scholar 

  5. Lenke L, Betz R, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83A:1169–1181

    Google Scholar 

  6. Frez R, Cheng JC, Wong EM (2000) Longitudinal changes in trunkal balance after selective fusion of King II curves in adolescent idiopathic scoliosis. Spine 25(11):1352–1359

    Article  PubMed  CAS  Google Scholar 

  7. Large DF, Doig WG, Dickens DR et al (1991) Surgical treatment of double major scoliosis. Improvement of the lumbar curve after fusion of the thoracic curve. J Bone Joint Surg Br 73(1):121–124

    PubMed  CAS  Google Scholar 

  8. Lenke LG, Betz RR, Bridwell KH et al (1999) Spontaneous lumbar curve coronal correction after selective anterior or posterior thoracic fusion in adolescent idiopathic scoliosis. Spine 24(16):1663–1671

    Article  PubMed  CAS  Google Scholar 

  9. Richards S (1992) Lumbar curve response in type II idiopathic scoliosis after posterior instrumentation of the thoracic spine. Spine 17(8 Suppl):S282–S286

    Article  PubMed  CAS  Google Scholar 

  10. McCance S, Denis F, Lonstein J et al (1998) Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King II curve pattern. Spine 23(19):2063–2073

    Article  PubMed  CAS  Google Scholar 

  11. Bridwell K, McAllister J, Betz R et al (1991) Coronal decompensation produced by Cotrel-Dubousset ‘derotation’ maneuver for idiopathic right thoracic scoliosis. Spine 16:769–777

    Article  PubMed  CAS  Google Scholar 

  12. Lenke L, Bridwell K, Baldus C et al (1992) Preventing decompensation in King Type II curves treated with Cotrel-Dubousset instrumentation: strict guidelines for selective fusion. Spine 17(8 Suppl):274–281

    Article  Google Scholar 

  13. Jansen RC, van Rhijn LW, Duinkerke E et al (2007) Predictability of the spontaneous lumbar curve correction after selective thoracic fusion in idiopathic scoliosis. Eur Spine J 16(9):1335–1342

    Article  PubMed  Google Scholar 

  14. Edwards CC 2nd, Lenke LG, Peelle M et al (2004) Selective thoracic fusion for adolescent idiopathic scoliosis with C modifier lumbar curves: 2- to 16-year radiographic and clinical results. Spine 29(5):536–46

    Google Scholar 

  15. Patel PN, Upasani VV, Bastrom TP et al (2008) Spontaneous lumbar curve correction in selective thoracic fusions of idiopathic scoliosis: a comparison of anterior and posterior approaches. Spine 3(10):1068–1073

    Article  Google Scholar 

  16. Sponseller PD, Betz R, Newton PO et al (2009) Differences in curve behavior after fusion in adolescent idiopathic scoliosis patients with open triradiate cartilages. Spine 34(8):827–831

    Article  PubMed  Google Scholar 

  17. Schlechter J, Newton P, Upasani V, et al (2009) Risk Factors for Distal Adding-on Identified: What to Watch Out For. American Association of Orthopaedic Surgeons Annual Meeting; P130

  18. Parisini P, Di Silvestre M, Lolli F et al (2009) Selective thoracic surgery in the Lenke type 1A: King III and King IV type curves. Eur Spine J 18(Suppl 1):82–88

    Article  PubMed  Google Scholar 

  19. Wang Y, Hansen ES, Høy K et al (2011) Distal adding-on Phenomenon in Lenke 1A Scoliosis: Risk Factor Identification and Treatment Strategy Comparison. Spine 36(14):1113–1122

    Article  PubMed  Google Scholar 

  20. Lenke LG, Edwards CC 2nd, Bridwell KH (2003) The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine 28(20):S199–S207

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics E, Aarhus University Hospital, Aarhus, Denmark

    Yu Wang, Cody Eric Bünger, Yanqun Zhang & Ebbe Stender Hansen

  2. Department of Orthopaedics, Peking University First Hospital, Beijing, China

    Yu Wang

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  1. Yu Wang
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  2. Cody Eric Bünger
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  3. Yanqun Zhang
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  4. Ebbe Stender Hansen
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Correspondence to Yu Wang.

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Wang, Y., Bünger, C.E., Zhang, Y. et al. Extensive fusion for Lenke 3C and 6C scoliosis: a two year radiographic follow-up. International Orthopaedics (SICOT) 36, 795–801 (2012). https://doi.org/10.1007/s00264-011-1331-6

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  • DOI: https://doi.org/10.1007/s00264-011-1331-6

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