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Postoperative behavior of thoracolumbar/lumbar curve and coronal balance after posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Controversy still exists around surgical strategies for Lenke type 1C and 2C curves with primary thoracic and compensatory lumbar curves in adolescent idiopathic scoliosis (AIS). The benefit of selective thoracic fusion (STF) for these curve types is spontaneous lumbar curve correction while saving more mobile lumbar segments. However, a risk of postoperative coronal decompensation after STF has also been reported. This multicenter retrospective study was conducted to evaluate postoperative behavior of thoracolumbar/lumbar (TLL) curve and coronal balance after posterior thoracic fusion for Lenke 1C and 2C AIS.

Methods

Twenty-four Lenke 1C and 2C AIS patients who underwent posterior thoracic fusion were included. The mean age of patients was 15.7 years old at time of surgery. Constructs used for surgery in all cases were pedicle screw constructs ending at L3 or above. Radiographic measurements were performed on Cobb angles of the main thoracic and TLL curves and coronal balance. Factors related to final Cobb angle of TLL curve and postoperative change of coronal balance were investigated.

Results

Mean Cobb angles for main thoracic and TLL curves were 59.0° and 43.9° preoperatively, and were corrected to 21.5° and 22.0° at final follow-up, respectively. Mean coronal balance was −5.6 mm preoperatively and was corrected to −14.6 mm at final follow-up. Final Cobb angle of TLL curve was significantly correlated with immediate postoperative Cobb angle of main thoracic curve and tilt of lowest instrumented vertebra (LIV). Postoperative change of coronal balance was significantly correlated with selection of LIV relative to stable vertebra.

Conclusion

Spontaneous correction of TLL curve occurred consistently by correcting the main thoracic curve and making the LIV more horizontal after posterior thoracic fusion for Lenke 1C and 2C AIS. The more distal fixation to stable vertebra resulted in coronal balance shifting more to the left postoperatively.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Spine and Spinal Cord Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan

    Masayuki Ishikawa, Yuta Shiono, Makoto Nishiyama & Yasuyuki Fukui

  2. Department of Orthopedic Surgery, School of Medicine, Keio University, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan

    Kai Cao, Long Pang, Kota Watanabe, Naobumi Hosogane & Morio Matsumoto

  3. Department of Orthopedic Surgery, Murayama Medical Center, Tokyo, Japan

    Mitsuru Yagi & Masafumi Machida

  4. Keio Spine Research Group, Keio University, Tokyo, Japan

    Masayuki Ishikawa, Kai Cao, Long Pang, Kota Watanabe, Mitsuru Yagi, Naobumi Hosogane, Yuta Shiono, Yasuyuki Fukui & Morio Matsumoto

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  1. Masayuki Ishikawa
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  2. Kai Cao
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  3. Long Pang
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  4. Kota Watanabe
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  5. Mitsuru Yagi
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  6. Naobumi Hosogane
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  7. Masafumi Machida
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  8. Yuta Shiono
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  9. Makoto Nishiyama
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  10. Yasuyuki Fukui
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  11. Morio Matsumoto
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Correspondence to Morio Matsumoto.

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Ishikawa, M., Cao, K., Pang, L. et al. Postoperative behavior of thoracolumbar/lumbar curve and coronal balance after posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis. J Orthop Sci 20, 31–37 (2015). https://doi.org/10.1007/s00776-014-0655-7

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  • DOI: https://doi.org/10.1007/s00776-014-0655-7

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