Results of selective thoracic versus nonselective fusion in lenke type 3 curves

Anuj Singla, James T. Bennett, Paul David Sponseller, Joshua M. Pahys, Michelle C. Marks, Baron S. Lonner, Peter O. Newton, Firoz Miyanji, Randal R. Betz, Patrick J. Cahill, Amer F. Samdani

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: A retrospective analysis of a prospectively collected multicenter database. OBJECTIVE.: To identify the radiographical and clinical outcomes in Lenke 3 curves fused selectively (S) versus nonselectively (NS). SUMMARY OF BACKGROUND DATA.: Surgical treatment options for Lenke 3 curves include fusion of both curves (NS) or selective thoracic curve fusion (S). Selective fusion of the thoracic curve spares lumbar motion segments; however, it may result in marked residual deformity. METHODS.: A prospectively collected multicenter database was retrospectively reviewed for adolescent idiopathic scoliosis Lenke 3 curves treated with posterior spinal fusion with a minimum of 2 years of follow-up. Patients were divided into 2 groups: NS (nonselective fusion) and S (selective thoracic fusion). Radiographical and clinical data were compared between the groups using the unpaired Student t test and analysis of variance. RESULTS.: A total of 74 patients met our inclusion criteria, with 49 (66.2%) in the NS group and 25 (33.8%) in the S group. Overall, both groups were similar preoperatively except for lumbar Cobb (NS = 56.3°, S = 47.2°, P <0.001), lumbar lordosis (NS = 56.9°, S = 67.2°, P = 0.001), lumbar rotational prominence (NS = 11.2°, S = 8.2°, P <0.05), and lumbar apical translation (NS = 3.2 cm, S = 1.9 cm, P <0.05). Postoperatively, NS fusion demonstrated significantly less coronal imbalance of 2 cm or less (NS = 10.2%, S = 56.0%, P <0.001), better lumbar curve correction (NS = 68.2%, S = 51.9%, P <0.001), better lumbar apical translation correction (NS = 1.2 cm, S = 2.1 cm, P <0.01), and better percent correction of the lumbar prominence (NS = 66.5%, S = 40.4%, P <0.05). Scoliosis Research Society Questionnaire 22 scores at 2 years were similar between the groups. CONCLUSION.: Despite preoperatively smaller lumbar curves with less apical translation and lumbar prominence, most patients with selective fusions were out of balance postoperatively and had inferior radiographical outcomes as compared with their nonselective comparison cohort with similar patient-reported outcomes. Long-term follow-up is required to determine whether the trade-off of sparing motion segments at the expense of somewhat lessened radiographical outcomes is worthwhile.Level of Evidence: 2.

Original languageEnglish (US)
Pages (from-to)2034-2041
Number of pages8
JournalSpine
Volume39
Issue number24
DOIs
StatePublished - Nov 15 2014

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Thorax
Scoliosis
Databases
Lordosis
Spinal Fusion
Analysis of Variance
Students
Research
Therapeutics
Patient Reported Outcome Measures
Surveys and Questionnaires

Keywords

  • AIS
  • fusion level
  • Lenke 3
  • nonselective
  • scoliosis
  • selective

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Singla, A., Bennett, J. T., Sponseller, P. D., Pahys, J. M., Marks, M. C., Lonner, B. S., ... Samdani, A. F. (2014). Results of selective thoracic versus nonselective fusion in lenke type 3 curves. Spine, 39(24), 2034-2041. https://doi.org/10.1097/BRS.0000000000000623

Results of selective thoracic versus nonselective fusion in lenke type 3 curves. / Singla, Anuj; Bennett, James T.; Sponseller, Paul David; Pahys, Joshua M.; Marks, Michelle C.; Lonner, Baron S.; Newton, Peter O.; Miyanji, Firoz; Betz, Randal R.; Cahill, Patrick J.; Samdani, Amer F.

In: Spine, Vol. 39, No. 24, 15.11.2014, p. 2034-2041.

Research output: Contribution to journalArticle

Singla, A, Bennett, JT, Sponseller, PD, Pahys, JM, Marks, MC, Lonner, BS, Newton, PO, Miyanji, F, Betz, RR, Cahill, PJ & Samdani, AF 2014, 'Results of selective thoracic versus nonselective fusion in lenke type 3 curves', Spine, vol. 39, no. 24, pp. 2034-2041. https://doi.org/10.1097/BRS.0000000000000623
Singla, Anuj ; Bennett, James T. ; Sponseller, Paul David ; Pahys, Joshua M. ; Marks, Michelle C. ; Lonner, Baron S. ; Newton, Peter O. ; Miyanji, Firoz ; Betz, Randal R. ; Cahill, Patrick J. ; Samdani, Amer F. / Results of selective thoracic versus nonselective fusion in lenke type 3 curves. In: Spine. 2014 ; Vol. 39, No. 24. pp. 2034-2041.
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abstract = "STUDY DESIGN.: A retrospective analysis of a prospectively collected multicenter database. OBJECTIVE.: To identify the radiographical and clinical outcomes in Lenke 3 curves fused selectively (S) versus nonselectively (NS). SUMMARY OF BACKGROUND DATA.: Surgical treatment options for Lenke 3 curves include fusion of both curves (NS) or selective thoracic curve fusion (S). Selective fusion of the thoracic curve spares lumbar motion segments; however, it may result in marked residual deformity. METHODS.: A prospectively collected multicenter database was retrospectively reviewed for adolescent idiopathic scoliosis Lenke 3 curves treated with posterior spinal fusion with a minimum of 2 years of follow-up. Patients were divided into 2 groups: NS (nonselective fusion) and S (selective thoracic fusion). Radiographical and clinical data were compared between the groups using the unpaired Student t test and analysis of variance. RESULTS.: A total of 74 patients met our inclusion criteria, with 49 (66.2{\%}) in the NS group and 25 (33.8{\%}) in the S group. Overall, both groups were similar preoperatively except for lumbar Cobb (NS = 56.3°, S = 47.2°, P <0.001), lumbar lordosis (NS = 56.9°, S = 67.2°, P = 0.001), lumbar rotational prominence (NS = 11.2°, S = 8.2°, P <0.05), and lumbar apical translation (NS = 3.2 cm, S = 1.9 cm, P <0.05). Postoperatively, NS fusion demonstrated significantly less coronal imbalance of 2 cm or less (NS = 10.2{\%}, S = 56.0{\%}, P <0.001), better lumbar curve correction (NS = 68.2{\%}, S = 51.9{\%}, P <0.001), better lumbar apical translation correction (NS = 1.2 cm, S = 2.1 cm, P <0.01), and better percent correction of the lumbar prominence (NS = 66.5{\%}, S = 40.4{\%}, P <0.05). Scoliosis Research Society Questionnaire 22 scores at 2 years were similar between the groups. CONCLUSION.: Despite preoperatively smaller lumbar curves with less apical translation and lumbar prominence, most patients with selective fusions were out of balance postoperatively and had inferior radiographical outcomes as compared with their nonselective comparison cohort with similar patient-reported outcomes. Long-term follow-up is required to determine whether the trade-off of sparing motion segments at the expense of somewhat lessened radiographical outcomes is worthwhile.Level of Evidence: 2.",
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T1 - Results of selective thoracic versus nonselective fusion in lenke type 3 curves

AU - Singla, Anuj

AU - Bennett, James T.

AU - Sponseller, Paul David

AU - Pahys, Joshua M.

AU - Marks, Michelle C.

AU - Lonner, Baron S.

AU - Newton, Peter O.

AU - Miyanji, Firoz

AU - Betz, Randal R.

AU - Cahill, Patrick J.

AU - Samdani, Amer F.

PY - 2014/11/15

Y1 - 2014/11/15

N2 - STUDY DESIGN.: A retrospective analysis of a prospectively collected multicenter database. OBJECTIVE.: To identify the radiographical and clinical outcomes in Lenke 3 curves fused selectively (S) versus nonselectively (NS). SUMMARY OF BACKGROUND DATA.: Surgical treatment options for Lenke 3 curves include fusion of both curves (NS) or selective thoracic curve fusion (S). Selective fusion of the thoracic curve spares lumbar motion segments; however, it may result in marked residual deformity. METHODS.: A prospectively collected multicenter database was retrospectively reviewed for adolescent idiopathic scoliosis Lenke 3 curves treated with posterior spinal fusion with a minimum of 2 years of follow-up. Patients were divided into 2 groups: NS (nonselective fusion) and S (selective thoracic fusion). Radiographical and clinical data were compared between the groups using the unpaired Student t test and analysis of variance. RESULTS.: A total of 74 patients met our inclusion criteria, with 49 (66.2%) in the NS group and 25 (33.8%) in the S group. Overall, both groups were similar preoperatively except for lumbar Cobb (NS = 56.3°, S = 47.2°, P <0.001), lumbar lordosis (NS = 56.9°, S = 67.2°, P = 0.001), lumbar rotational prominence (NS = 11.2°, S = 8.2°, P <0.05), and lumbar apical translation (NS = 3.2 cm, S = 1.9 cm, P <0.05). Postoperatively, NS fusion demonstrated significantly less coronal imbalance of 2 cm or less (NS = 10.2%, S = 56.0%, P <0.001), better lumbar curve correction (NS = 68.2%, S = 51.9%, P <0.001), better lumbar apical translation correction (NS = 1.2 cm, S = 2.1 cm, P <0.01), and better percent correction of the lumbar prominence (NS = 66.5%, S = 40.4%, P <0.05). Scoliosis Research Society Questionnaire 22 scores at 2 years were similar between the groups. CONCLUSION.: Despite preoperatively smaller lumbar curves with less apical translation and lumbar prominence, most patients with selective fusions were out of balance postoperatively and had inferior radiographical outcomes as compared with their nonselective comparison cohort with similar patient-reported outcomes. Long-term follow-up is required to determine whether the trade-off of sparing motion segments at the expense of somewhat lessened radiographical outcomes is worthwhile.Level of Evidence: 2.

AB - STUDY DESIGN.: A retrospective analysis of a prospectively collected multicenter database. OBJECTIVE.: To identify the radiographical and clinical outcomes in Lenke 3 curves fused selectively (S) versus nonselectively (NS). SUMMARY OF BACKGROUND DATA.: Surgical treatment options for Lenke 3 curves include fusion of both curves (NS) or selective thoracic curve fusion (S). Selective fusion of the thoracic curve spares lumbar motion segments; however, it may result in marked residual deformity. METHODS.: A prospectively collected multicenter database was retrospectively reviewed for adolescent idiopathic scoliosis Lenke 3 curves treated with posterior spinal fusion with a minimum of 2 years of follow-up. Patients were divided into 2 groups: NS (nonselective fusion) and S (selective thoracic fusion). Radiographical and clinical data were compared between the groups using the unpaired Student t test and analysis of variance. RESULTS.: A total of 74 patients met our inclusion criteria, with 49 (66.2%) in the NS group and 25 (33.8%) in the S group. Overall, both groups were similar preoperatively except for lumbar Cobb (NS = 56.3°, S = 47.2°, P <0.001), lumbar lordosis (NS = 56.9°, S = 67.2°, P = 0.001), lumbar rotational prominence (NS = 11.2°, S = 8.2°, P <0.05), and lumbar apical translation (NS = 3.2 cm, S = 1.9 cm, P <0.05). Postoperatively, NS fusion demonstrated significantly less coronal imbalance of 2 cm or less (NS = 10.2%, S = 56.0%, P <0.001), better lumbar curve correction (NS = 68.2%, S = 51.9%, P <0.001), better lumbar apical translation correction (NS = 1.2 cm, S = 2.1 cm, P <0.01), and better percent correction of the lumbar prominence (NS = 66.5%, S = 40.4%, P <0.05). Scoliosis Research Society Questionnaire 22 scores at 2 years were similar between the groups. CONCLUSION.: Despite preoperatively smaller lumbar curves with less apical translation and lumbar prominence, most patients with selective fusions were out of balance postoperatively and had inferior radiographical outcomes as compared with their nonselective comparison cohort with similar patient-reported outcomes. Long-term follow-up is required to determine whether the trade-off of sparing motion segments at the expense of somewhat lessened radiographical outcomes is worthwhile.Level of Evidence: 2.

KW - AIS

KW - fusion level

KW - Lenke 3

KW - nonselective

KW - scoliosis

KW - selective

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