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Isolated main thoracic curve fusion in idiopathic scoliosis: optimizing radiographic outcomes using lumbar modifiers to guide correction

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Abstract

Purpose

Does differential correction of main thoracic curve (MTC) and instrumented LIV angulation based on lumbar modifiers affect radiographic outcomes, and can preoperative supine AP radiograph be used to guide correction for optimal final radiographic alignment.

Methods

Retrospective analysis of idiopathic scoliosis patients who underwent selective thoracic fusions (LIV T11-L1) for Lenke 1 and 2 curve patterns, < 18 years of age. 2-year minimum follow-up. Optimal outcome meant LIV + 1 of < 5 degrees disk-wedging and C7-CSVL < 2 cm. 82 patients met inclusion criteria (70% female), mean age 14.1 years.

Results

24 patients were A modifier, 21 B modifier, and 37 C modifier. There were 52 optimal and 30 suboptimal outcomes. LIV was not associated with outcome (p = 0.08). For optimal outcomes, A modifiers’ MTC improved 65%, B modifiers 65%, and C modifiers 59%. C modifiers’ MTC correction was less than A modifiers (p = 0.03) but equivalent to B modifiers’ (p = 0.10). A modifiers’ LIV + 1 tilt improved 65%, B modifiers 64%, and C modifiers 56%. C modifiers’ instrumented LIV angulation was greater than A modifiers’ (p < 0.01) but equivalent to B modifiers’ (p = 0.06). Preoperative supine LIV + 1 tilt was 16o in optimal outcomes and 15° in suboptimal outcomes. Instrumented LIV angulation was 9° for both. The correction between preoperative LIV + 1 tilt and instrumented LIV angulation was not significantly different between groups (p = 0.67).

Conclusion

Differential MTC and LIV tilt correction based on lumbar modifier may be a valid goal. Optimizing radiographic outcome by matching instrumented LIV angulation to preoperative supine LIV + 1 tilt could not be proven.

Level of evidence

IV.

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Data availability

Data is available upon request.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Children’s Place, Suite 4S60, St. Louis, MO, 63110, USA

    Thomas Bane & Scott J. Luhmann

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  1. Thomas Bane
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  2. Scott J. Luhmann
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Contributions

TB and SJL substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Scott J. Luhmann.

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No human subjects or animals participated. Therefore, no informed consent was obtained. IRB approval was obtained from Washington University Institutional Review Board, IRB# 201203118.

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Bane, T., Luhmann, S.J. Isolated main thoracic curve fusion in idiopathic scoliosis: optimizing radiographic outcomes using lumbar modifiers to guide correction. Spine Deform 11, 657–664 (2023). https://doi.org/10.1007/s43390-023-00650-9

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