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Outcomes of selective thoracic fusion for Lenke 1 adolescent idiopathic scoliosis: predictors of success from the sagittal plane

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Abstract

Purpose

To determine the link between the rate of spontaneous lumbar curve correction (SLCC) and the sagittal profile characteristics both before and after selective thoracic fusion in Lenke 1 adolescent idiopathic scoliosis (AIS).

Methods

Sixty-three Lenke 1 B and C were enrolled and followed up to 2 years. Twenty non-scoliotic controls were included. 3D reconstruction of the spine was generated from bi-planar X-rays at pre-operative, first erect post-operative, and the most recent follow-up. The 3D spinal models were used to determine the frontal and sagittal Cobb angles and 3D coordinate of each vertebral centroid. A K-mean cluster analysis allocated patients into two groups based on the rate of SLCC between the pre-operative and the most recent follow-up visits (SLCCHigh and SLCCLow groups). The ratio of the thoracic to lumbar curve apical translations in sagittal plane was determined. ANOVA test compared the sagittal apical translation ratio between the three visits of the AIS clusters and between the AIS groups and controls.

Results

The rate of the SLCC was significantly different between the two clusters: 31% (SLCCLow) versus 76% (SLCCHigh). No significant difference was found between the two clusters pre-operative Cobb angles, kyphosis, and lordosis. The pre-operative ratio of the thoracic to lumbar apical translation in the sagittal plane was significantly lower in SLCCHigh compared to SLCCLow group, a magnitude of 1.2 and 2.2, respectively, p < 0.05.

Conclusion

In Lenke 1, patients with a higher pre-operative sagittal thoracic to lumbar apical translation ratio are associated with lower rate of SLCC at the most recent follow-up.

Graphical abstract

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Acknowledgements

This study received research Grant funding from Scoliosis Research Society and was approved by the Institutional Review Board. The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA

    Saba Pasha, John M. Flynn & Wudbhav N. Sankar

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  1. Saba Pasha
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  2. John M. Flynn
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  3. Wudbhav N. Sankar
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Correspondence to Saba Pasha.

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The authors report no conflicts of interest relevant to this submission.

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Pasha, S., Flynn, J.M. & Sankar, W.N. Outcomes of selective thoracic fusion for Lenke 1 adolescent idiopathic scoliosis: predictors of success from the sagittal plane. Eur Spine J 27, 2223–2232 (2018). https://doi.org/10.1007/s00586-018-5553-9

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  • DOI: https://doi.org/10.1007/s00586-018-5553-9

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