The Surgical Overcorrection of Lenke Type 1 Deformities with Selective Fusion Segments: What Happens to the Coronal Balance?

PURPOSE: The aim of our study is to determine the alterations on coronal balance after overcorrection of Lenke type 1 curve, retrospectively. METHODS: Datas of 34 patients (29 female, 5 male patients; mean age, 16.3±3.3 years; range, 13-24 years) surgically treated for scoliosis between 2004 and 2010 were reviewed, retrospectively. The adolescent idiopathic scoliosis patients with Lenke type 1 curve treated with only posterior pedicle screw and postoperative thoracic curves less than 10° by Cobb method on frontal plane were enrolled in this study. Mean follow-up period was 52.5±29.7 months. RESULTS: The mean amount of the preoperative thoracic curves was measured as 41.2°±6.1° (range, 30°-56°). The mean amount of the early postoperative thoracic curves was measured as 6.5°±1.8° (range, 3°-9°). The mean amount of the thoracic curves was measured as 8.5°±4.6° (range, 3°-22°) during the last follow-up (p=0.01). The mean preoperative coronal balance was measured as 8.5mm(range, 1-30mm). The mean early postoperative coronal balance was measured as 3.5mm(range, 0-36 mm). The mean coronal balance was measured as 5.5mm(range, 0-38mm) during the last follow-up (p>0.05). CONCLUSION: We suggest that Lenke type 1B and 1C should be carefully evaluated and the fusion levels should be accurately selected in order to maintain the correction of coronal balance. We suggest that selective fusion with overcorrection in Lenke type 1A are applied to curves that can be corrected lumbar curve at the preoperative bending radiograph and curves that not have coronal decompensation and >10° distal junctional kyphosis, preoperatively.

Decision Making Algorithm for Adult Spinal Deformity Surgery

Adult spinal deformity (ASD) is one of the most challenging spinal disorders associated with broad range of clinical and radiological presentation. Correct selection of fusion levels in surgical planning for the management of adult spinal deformity is a complex task. Several classification systems and algorithms exist to assist surgeons in determining the appropriate levels to be instrumented. In this study, we describe our new simple decision making algorithm and selection of fusion level for ASD surgery in terms of adult idiopathic idiopathic scoliosis vs. degenerative scoliosis.

Comparison of spontaneous correction in thoracic curves after selective anterior versus posterior fusion in Lenke5 adolescent idiopathic scoliosis / 中国矫形外科杂志

[Objective]To compare spontaneous correction of the unfused thoracic curves after selective anterior versus posterior fusion in Lenke5 adolescent idiopathic scoliosis(AIS). [Method]A total of 72 Lenke5 AIS patients were rescruited from May 1997 to October 2005.Out of them,40 received selective anterior fusion(group A) and 32 received selective posterior fusion(group B).All had a minimum of 2-year follow-up.[Result] No complication were found in both groups at the latest follow-up.The thoracic curve was corrected from 30? to 16? for group A,33? to 18? for group B.Both groups had a better spontaneous correction of the unfused thoracic curves.The correction rate had no significant difference between groups.However,the thoracic curve was increased in four patients(2 in each group;group C),which resulted in trunk imbalance.The thoracolumbar/lumbar thoracic(TL/L:T) Cobb's ratio averaged 1.09 in the four patients whereas 1.59 in other 68 patients(group D).The flexibility of the thoracic curve had significant difference in group C and D(34.2% vs 57.3%).[Conclusion]Both of the surgical treatments can get a better spontaneous correction of the unfused thoracic curves.It is important to evaluate the.thoracolumbar/lumbar–thoracic(TL/L:T) Cobb's ratio and the flexibility of the thoracic curve before selective fusion.