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Anterior Spinal Fusion and Posterior Spinal Fusion Both Effectively Treat Lenke Type 5 Curves in Adolescent Idiopathic Scoliosis: A Multicenter Study

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Abstract

Study Design

Retrospective cohort study.

Objective

Retrospective comparison of radiographic and clinical outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in surgical treatment of Lenke 5 curves.

Summary of Background Data

ASF and PSF are used for treatment of Lenke 5 curves in patients with adolescent idiopathic scoliosis (AIS). Currently, no consensus exists for optimal surgical treatment of Lenke 5 curves.

Methods

Patients with Lenke 5 curves treated with either ASF or PSF were prospectively enrolled in a multicenter database and then retrospectively reviewed. Demographic data, perioperative measures, radiographic data, and SRS-22R scores were collected and compared for statistical significance.

Results

A total of 149 patients were included in the study; 51 underwent PSF and 98 underwent ASF. There was no difference in demographics between groups. The PSF group was fused one level longer than the ASF group (5.9 levels PSF, 4.6 levels ASF, p < .0001). The PSF group had shorter operative times (223 minutes PSF, 297 minutes ASF; p < .0001) and a higher proportion of patients who received a postoperative blood transfusion (45% vs. 5%, p < .0001). PSF patients had longer hospital stays (6.1d PSF vs. 5d ASF, p = .031). The ASF group had larger preoperative major curve (48.2° ASF, 44.2° PSF; p < .01). Coronal balance, thoracolumbar/lumbar Cobb angle, shoulder height, trunk shift, and overall sagittal balance were not different between groups at two-year follow-up. Curve correction at two-year follow-up was similar between groups (66% ASF vs. 62% PSF). There were no significant differences in clinical outcomes or complication rates between groups.

Conclusion

There is no difference in radiographic or clinical outcomes in patients treated with ASF or PSF for Lenke 5 curves. ASF may save a fusion level, but has longer operative time than PSF. Ultimately, the risks and benefits of each approach merit consideration by surgeon and patient.

Level of Evidence

Level II.

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Author information

Authors and Affiliations

  1. Children’s Hospital Colorado, 13123 East 16th Avenue, Box 060, 80045, Aurora, CO, USA

    Courtney O’Donnell MD, Nicole Michael BA, Sumeet Garg MD & Mark Erickson MD, MMM

  2. University of Colorado Anschutz, 13001 E 17th PI, 80045, Aurora, CO, USA

    X. Pan PhD

  3. Boston Children’s Hospital, 300 Longwood Ave, 02115, Boston, MA, USA

    John Emans MD

Authors
  1. Courtney O’Donnell MD
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  2. Nicole Michael BA
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  3. X. Pan PhD
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  4. John Emans MD
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  5. Sumeet Garg MD
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  6. Mark Erickson MD, MMM
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Corresponding author

Correspondence to Mark Erickson MD, MMM.

Additional information

Author disclosures: CO (none); NM (none); XP (none); JE (other from Synthes, Medtronics, and the Journal of Children’s Orthopedics, outside the submitted work); SG (personal fees from Decision Support in Medicine, Medtronic, and Mighty Oak Medical; other from Pediatric Orthopaedic Society of North America, Scoliosis Research Society, and US News & World Report Best Children’s Hospitals Orthopedics Working Group, outside the submitted work); ME (other from the Pediatric Orthopaedic Society of North America, personal fees from Biomet, outside the submitted work).

All of the data for the present study were obtained via the SDSG, which was directly supported by Medtronic as a corporate sponsor.

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O’Donnell, C., Michael, N., Pan, X. et al. Anterior Spinal Fusion and Posterior Spinal Fusion Both Effectively Treat Lenke Type 5 Curves in Adolescent Idiopathic Scoliosis: A Multicenter Study. Spine Deform 6, 231–240 (2018). https://doi.org/10.1016/j.jspd.2017.09.054

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  • DOI: https://doi.org/10.1016/j.jspd.2017.09.054

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