Abstract
Introduction
To evaluate clinical and radiological outcome of selective fusion for adolescent idiopathic scoliosis (AIS) in thoraco-lumbar curves i.e., Lenke 5C curves.
Material and Methods
Twelve(12) patients with Lenke 5C curves were operated through posterior approach for AIS. Risser stage at the time of operation was 0–3 in 6patients and more than 3 in 4patients. Mean age was 13.5 years. Not every vertebra was instrumented with pedicle screws. Apical vertebral derotation and translation on the concave side were performed for correction. All patients underwent a selective fusion (5C only thoracolumbar/lumbar curve fused). The data were prospectively collected preoperatively and at 6 weeks, 1year and 2years post-operatively. Cobb angle, sagittal and coronal balance, and lowest fused vertebral tilt were documented at all time-points. Uninstrumented compensatory curves were measured at all time points.
Results
The average thoracolumbar/lumbar (TL/L) preoperative Cobb angle in Lenke5C curves was 46° ± 8° which was corrected to 14° ± 7° (70% correction) at a 2-year follow-up. 25% of the uninstrumented thoracic curve had spontaneous correction. The coronal balance improved significantly (p < 0.05) and remained stable from the first postoperative visit to the 2-year follow-up visit. The SRS-22 total scores improved significantly from before surgery to 2years after surgery (p < 0.0001). No pseudarthrosis or reoperation was observed.
Conclusion
Posterior correction of thoracolumbar AIS with pedicle screw instrumentation is safe and produces a long-term stable correction and high patient satisfaction. In Lenke 5C AIS deformity patterns fused selectively, the uninstrumented compensatory curves do not seem to progress. Selective fusions, when successfully performed, will optimize mobile segments of the spine in AIS patients.