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Ohrt-Nissen S, Cheung PWH, Kawasaki S, Shigematsu H, Cheung JPY. Curve Overcorrection Predicts Coronal Imbalance in Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis. Global Spine J 2024; 14:856-861. [PMID: 36045481 DOI: 10.1177/21925682221124526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort Study. OBJECTIVES To identify predictive factors for coronal imbalance after selective fusion in adolescent idiopathic scoliosis (AIS) with Lenke type 1 curves. METHODS AIS patients with Lenke type 1 curve with A, B and C lumbar modifiers underwent selective thoracic fusion. The curve fulcrum flexibility and fulcrum bending correction index (FBCI) was studied. Coronal imbalance was defined as more than 2 cm of truncal shift or more than 2 cm list at two-year follow-up. RESULTS A total of 301 patients were included in the study. Coronal imbalance at two-year follow-up was found in 38 patients (13%). At the preoperative stage, we found a significant difference in main curve flexibility with 66±15% in the balanced group and 60±15% in the imbalanced group (P = .032). At the immediate postoperative stage, mean curve correction was 71±13% vs 70±13% and mean FBCI was 112±29% vs 122±29% in the balance and unbalanced group, respectively (P = .031). Postoperative FBCI of more than 125% (third quartile) resulted in an odds ratio of 2.1 (95%CI:1.1-4.3) for coronal imbalance at two years (P=.031). No significant changes in fusion mass or LIV tilt was observed. CONCLUSIONS A decreased preoperative flexibility and a higher FBCI was significantly associated with coronal imbalance. A high FBCI is an indication of a curve correction that exceeds the inherent flexibility of the spine, and our results add to a growing body of evidence that "overcorrection" of the main curve can lead to postoperative imbalance.
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Affiliation(s)
- Søren Ohrt-Nissen
- Spine Unit, Department of Orthopedic surgery, Copenhagen University Hospital, Denmark
| | | | - Sachiko Kawasaki
- Department of Orthopaedic Surgery, Nara Medical University, Shijo-cho Kashihara, Japan
| | - Hideki Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, Shijo-cho Kashihara, Japan
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
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Ogura Y, Larson AN, Blakemore L, Miyanji F, Andras LM, Parent S, El-Hawary R, Welborn MC. Coronal decompensation following thoracic vertebral body tethering in idiopathic scoliosis. Spine Deform 2024:10.1007/s43390-024-00855-6. [PMID: 38556582 DOI: 10.1007/s43390-024-00855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Post-operative coronal decompensation (CD) continues to be a challenge in the treatment of adolescent idiopathic scoliosis (AIS). CD following selective spinal fusion has been studied. However, there is currently little information regarding CD following Vertebral Body Tethering (VBT). Thus, the goal of this study is to better understand the incidence and risk factors for CD after VBT. METHODS Retrospective review of a prospective multicenter database was used for analysis. Inclusion criteria were patients undergoing thoracic VBT, a minimum 2-year follow-up, LIV was L1 or above, skeletally immature (Risser ≤ 1), and available preoperative and final follow-up AP and lateral upright radiographs. Radiographic parameters including major and minor Cobb angles, curve type, LIV tilt/translation, L4 tilt, and coronal balance were measured. CD was defined as the distance between C7PL and CSVL > 2 cm. Multiple logistic regression model was used to identify significant predictors of CD. RESULTS Out of 136 patients undergoing VBT, 94 patients (86 female and 6 male) met the inclusion criteria. The mean age at surgery was 12.1 (9-16) and mean follow-up period was 3.4 years (2-5 years). Major and minor curves, AVR, coronal balance, LIV translation, LIV tilt, L4 tilt were significantly improved after surgery. CD occurred in 11% at final follow-up. Lenke 1A-R (24%) and 1C (26%) had greater incidence of CD compared to 1A-L (4%), 2 (0%), and 3 (0%). LIV selection was not associated with CD. Multivariate logistic regression analysis yielded 1A-R and 1C curves as a predictor of CD with the odds ratio being 17.0. CONCLUSION CD occurred in 11% of our thoracic VBT patients. Lenke 1A-R and 1C curve types were predictors for CD in patients treated with VBT. There were no other preoperative predictors associated with CD.
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Affiliation(s)
- Yoji Ogura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - A Noelle Larson
- Department of Pediatric Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Laurel Blakemore
- Department of Pediatric Orthopaedic Surgery, Pediatric Specialists of Virginia, Merrifield, VA, USA
| | - Firoz Miyanji
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay M Andras
- Department of Pediatric Orthopedic Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Stefan Parent
- Department of Orthopaedic Surgery, Hospital Ste-Justine (HSJ), Montreal, QC, Canada
| | - Ron El-Hawary
- Department of Orthopaedic Surgery, IWK Health Centre, Halifax, NS, Canada
| | - Michelle Cameron Welborn
- Shriners Hospital for Children Portland, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA.
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Zhang Y, Bai J, Xiao B, Zhang J, He D, Xing Y, Liu B. Satisfactory immediate spontaneous correction may not mean satisfactory final results for moderate TL/L curves after selective thoracic fusion in AIS patients. BMC Musculoskelet Disord 2023; 24:543. [PMID: 37393267 PMCID: PMC10314374 DOI: 10.1186/s12891-023-06591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/01/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Few studies have focused on the chronic spontaneous behavior of the unfused TL/L curve during follow-up. The purpose of the present study was to explore the behavior of the unfused TL/L curve during a long-term follow-up to identify the risk factors for correction loss. METHODS Sixty-four age-matched female AIS patients undergoing selective thoracic fusion were enrolled. Patients were divided into 2 groups according to whether there was correction loss. Risk factors for correction loss of the unfused TL/L curves were analyzed. The relationship and difference between the immediate postoperative thoracic and TL/L Cobb angles were explored. RESULTS The TL/L Cobb angle was 28.17° before surgery, 8.60° after surgery, and 10.74° at the final follow-up, with a correction loss of 2.14°. Each subgroup contained 32 cases. A smaller postoperative TL/L Cobb angle was the only risk factor that was independently associated with TL/L correction loss. In the LOSS group, there was a significant difference and no correlation between the immediate postoperative TL/L and the thoracic Cobb angle. In the NO-LOSS group, there was a moderate correlation and no difference between them. CONCLUSION A smaller immediate postoperative TL/L Cobb angle may have been associated with TL/L correction loss during the long-term follow-up. Thus, good immediate postoperative spontaneous correction may not mean a satisfactory outcome at the final follow-up after STF. Mismatch between thoracic and TL/L Cobb angles immediately after surgery may also be related to correction loss of the unfused TL/L curves. Close attention should be paid in case of deterioration.
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Affiliation(s)
- Yanbin Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
| | - Jing Bai
- Department of Trauma and Joint, The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine, Chaoyang District Anwai Xiaoguan Street No. 51, Beijing, 100029 P.R. China
| | - Bin Xiao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
| | - Jianguo Zhang
- Department of Orthopedics of Peking Union Medical College Hospital, 1Shuai Fu Yuan, Beijing, 100730 P.R. China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
| | - Yonggang Xing
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
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Park SJ, Lee CS, Park JS, Ma CH, Shin TS, Jeon CY. Long-term Radiographic and Clinical Outcomes After Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis With Lenke 1C Curve. J Pediatr Orthop 2023; Publish Ahead of Print:01241398-990000000-00303. [PMID: 37311654 DOI: 10.1097/bpo.0000000000002444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the promising results with selective thoracic fusion (STF) in patients with adolescent idiopathic scoliosis (AIS) of the Lenke 1C curve, postoperative coronal imbalance and progression of the unfused lumbar curve have been concerns in long-term follow-up. In this study, we aimed to investigate the radiographic and clinical outcomes after STF for AIS with Lenke 1C curve with long-term follow-up. METHODS A total of 30 patients with AIS with Lenke 1C curves who underwent STF between 2005 and 2017 were included. Minimum follow-up duration was 5 years. Time-dependent changes in radiographic parameters were investigated preoperatively, immediately postoperatively, and at the last follow-up. In addition, radiographic adverse events such as coronal decompensation (CD), lumbar decompensation (LD), distal adding-on (DA) phenomenon, and trunk shift were evaluated at the last follow-up. The Scoliosis Research Society-22 score was used for clinical outcome evaluation. RESULTS The mean age at the time of surgery was 13.8 years. The mean follow-up duration was 6.7 ± 0.8 years. The main thoracic curve significantly improved from 57 degrees to 23 degrees (60% correction), and the thoracolumbar/lumbar curve significantly improved from 47 degrees to 28 degrees (41% correction). Coronal balance was 15 mm after surgery but significantly improved to 10 mm at the last follow-up (P = 0.033). At the final follow-up, 11 patients (37%) sustained at least one of the radiographic adverse events: CD in 5 patients (17%), LD in 3 (10%), DA in 4 (13%), and trunk shift in 3 (10.%). However, there were no cases requiring revision surgery. In addition, there were no significant differences in any items or total Scoliosis Research Society-22 score between the patients with and without radiographic adverse events. CONCLUSION STF in Lenke 1C curves showed an acceptable risk of adverse radiographic events such as CD, LD, DA, and trunk shift in long-term follow-up. We suggest that STF without fusion to the thoracolumbar/lumbar curve would be sufficient in treating AIS with Lenke 1C curve. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Se-Jun Park
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Chong-Suh Lee
- Department of Orthopaedic Surgery, Haeundae Bumin Hospital, Busan, South Korea
| | - Jin-Sung Park
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Chang-Hyun Ma
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Tae Soo Shin
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Chung-Youb Jeon
- Department of Orthopaedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Isogai N, Yagi M, Otomo N, Maeda Y, Suzuki S, Nori S, Tsuji O, Nagoshi N, Okada E, Fujita N, Nakamura M, Matsumoto M, Watanabe K. Upper End Vertebra of Proximal Thoracic Curve At T1 is a Novel Risk Factor of Postoperative Shoulder Imbalance in Lenke Type 2 Adolescent Idiopathic Scoliosis. Global Spine J 2023; 13:1223-1229. [PMID: 34121483 PMCID: PMC10416584 DOI: 10.1177/21925682211023049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective single-center study. OBJECTIVE We investigated the risk factors of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) including the position of preoperative upper end vertebra (UEV). METHODS Seventy-five patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries from 2008 to 2018 were included. We included only patients whose upper instrumented vertebrae were at T2. The patients were divided into 2 groups based on radiographic shoulder height (RSH) at final follow-up, namely PSI group and non-PSI group, and PSI was defined as RSH > 10 mm. UEV, RSH, Cobb angle, curve flexibility, T1 and T2 tilt, correction rate, Risser grade, Scoliosis Research Society-22 scores, and demographic data were compared between the groups using independent t-tests or chi-square tests. Variables with P value < 0.20 in univariate analysis were assessed in logistic regression analysis. RESULTS Thirty-four patients in the PSI group and 37 patients in the non-PSI group were analyzed. Univariate analysis revealed that there were more patients with UEV at T1 (PSI: 85%, non-PSI: 54%, P < 0.01) and Risser grade ≥ 3 (PSI: 88%, non-PSI: 62%; P < 0.05) in the PSI group than in the non-PSI group. Logistic regression analysis revealed that UEV at T1 (odds ratio [OR] = 4.1 [1.2-14.4], P < 0.05) and Risser grade ≥ 3 (OR = 3.9 [1.1-14.5], P < 0.05) are significantly associated with PSI. CONCLUSIONS UEV at T1 and Risser grade ≥ 3 at the time of surgery are significant risk factors of PSI.
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Affiliation(s)
- Norihiro Isogai
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Nao Otomo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Yoshihiro Maeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Nobuyuki Fujita
- Keio Spine Research Group, Tokyo, Japan
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group, Tokyo, Japan
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6
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Pan A, Hai Y, Lenke LG, Zheng Z, Yang J. Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis. J Pers Med 2023; 13:897. [PMID: 37373886 DOI: 10.3390/jpm13060897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Background: We aimed to propose the apical vertebras distribution modifier to supplement the coronal balance (CB) classification for adult idiopathic scoliosis (AdIS). An algorithm to predict postoperative coronal compensation and avoid postoperative coronal imbalance (CIB) was proposed. Methods: Patients were categorized into CB and CIB groups according to the preoperative coronal balance distance (CBD). The apical vertebras distribution modifier was defined as negative (-) if the centers of the apical vertebras (CoAVs) were on either side of the central sacral vertical line (CSVL) and positive (+) if the CoAVs were on the same side of the CSVL. Results: A total of 80 AdIS patients, with an average age of 25.97 ± 9.20 years, who underwent posterior spinal fusion (PSF) were prospectively recruited. The mean Cobb angle of the main curve was 107.25 ± 21.11 degrees at preoperation. The mean follow-up time was 3.76 ± 1.38 (2-8) years. At postoperation and follow-up, CIB occurred in 7 (70%) and 4 (40%) CB- patients, 23 (50%) and 13 (28.26%) CB+ patients, 6 (60%) and 6 (60%) CIB- patients, and 9 (64.29%) and 10 (71.43%) CIB+ patients. Health-related quality of life (HRQoL) was significantly better in the CIB- group compared with that of the CIB+ group in the dimension of back pain. To avoid postoperative CIB, the correction rate of the main curve (CRMC) should match the compensatory curve for CB-/+ patients; the CRMC should be greater than the compensatory curve for CIB- patients; and the CRMC should be less than the compensatory curve for CIB+ patients, and the inclination of the LIV needs to be reduced. Conclusions: CB+ patients have the least postoperative CIB rate and the best coronal compensatory ability. CIB+ patients are at a high risk of postoperative CIB and have the poorest coronal compensatory capacity in the event of postoperative CIB. The proposed surgical algorithm facilitates the handling of each type of coronal alignment.
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Affiliation(s)
- Aixing Pan
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yong Hai
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Lawrence G Lenke
- New York-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Zhaomin Zheng
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510062, China
| | - Jincai Yang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Zuckerman SL, Chanbour H, Hassan FM, Lai C, Kerolus M, Ha A, Buchannan I, Cerpa M, Lehman RA, Lenke LG. Patients With Coronal Malalignment Undergoing Adult Spinal Deformity Surgery: Does Coronal Alignment Change From Immediately Postoperative to 2-years? Clin Spine Surg 2023; 36:E14-E21. [PMID: 35858210 DOI: 10.1097/bsd.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The objectives were to: (1) characterize the changes in coronal vertical axis (CVA) after adult spinal deformity (ASD) surgery from immediate postoperative to 2-years postoperative, and (2) assess for predictors of CVA change from immediate postoperative to 2-years postoperative. SUMMARY OF BACKGROUND DATA It is unknown whether coronal correction obtained immediately postoperative accurately reflects long-term coronal alignment. MATERIALS AND METHODS A retrospective, single-institution registry was queried for patients undergoing ASD surgery from 2015-2019, including patients undergoing ≥6-level fusions with preoperative coronal malalignment (CM), defined as CVA≥3 cm. A clinically significant change in CVA was defined a priori as ≥1 cm. Radiographic variables were obtained preoperatively, immediately postoperative, and at 2-years postoperative. RESULTS Of 368 patients undergoing ASD surgery, 124 (33.7%) had preoperative CM, and 64 (17.0%) completed 2-years follow-up. Among 64 patients, mean age was 53.6±15.4 years. Preoperatively, absolute mean CVA was 5.4±3.1 cm, which improved to 2.3±2.0 cm ( P <0.001) immediately postoperative and 2.2±1.6 cm ( P <0.001) at 2-years. The mean change in CVA from preoperative to immediately postoperative was 2.2±1.9 cm (0.3-14.4). During the immediate postoperative to 2-years interval, 29/64 (45.3%) patients experienced a significant change of CVA by ≥1 cm, of which 22/29 (76%) improved by a mean of 1.7 cm and 7/29 (24%) worsened by a mean of 3.5 cm. No preoperative or surgical factors were associated with changed CVA from immediately postoperative to 2-years. CONCLUSION Among 64 patients undergoing ASD surgery with preoperative CM, 45.3% experienced a significant (≥1 cm) change in their CVA from immediately postoperative to 2-years postoperative. Of these 29 patients, 22/29 (76%) improved, whereas 7/29 (24%) worsened. Although no factors were associated with undergoing a change in CVA, this information is useful in understanding the evolution and spontaneous coronal alignment changes that take place after major ASD coronal plane correction.
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Affiliation(s)
- Scott L Zuckerman
- Departments of Neurological Surgery
- Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Fthimnir M Hassan
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Christopher Lai
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Mena Kerolus
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Alex Ha
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Ian Buchannan
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Meghan Cerpa
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
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Ifthekar S, Ahuja K, Sudhakar PV, Mittal S, Yadav G, Kandwal P, Sarkar B, Goyal N. Is it Safe to Save Levels and Choose the Lowest Instrumented Vertebra as Touched Vertebra While Selectively Fusing Lenke 1/2 Curves? A Proportional Meta-Analysis of Existing Evidence. Global Spine J 2023; 13:219-226. [PMID: 35392687 PMCID: PMC9837513 DOI: 10.1177/21925682221091744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To compare the clinical and radiological outcomes in patients with Adolescent Idiopathic scoliosis (AIS) treated by selective thoracic fusion (STF) with lowest instrumented vertebra (LIV) at touched vertebra (TV) vs stable vertebra (SV). METHODS The databases PubMed, Embase and Google Scholar were searched until November 2020.Studies which had Lenke type 1 curves and Lenke type 2 curves in adolescent population treated by STF and which reported pre- and post-operative curve characteristics including correction percentage and complications were included. Studies which did not report the LIV selection, curve correction percentages and whose full text could not be acquired were excluded. RESULTS Eight studies were included for analysis of which seven were found to be retrospective studies (level III evidence) and one was prospective study (level II evidence) each. Overall proportional meta-analysis found no significant difference in correction rate, total srs-22 scores, and complication rates. CONCLUSION The evaluation of SV group and TV group as LIV for selective thoracic fusions in AIS reveals a comparable outcome in terms of curve correction, patient satisfaction scores and complication rates. The TV can be chosen safely as the LIV especially in type A and B Lenke 1&2 curves, as it saves more motion segments when compared to SV.
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Affiliation(s)
- Syed Ifthekar
- Department of Orthopaedics, All India Institute of Medical
Sciences, Rishikesh, India
| | - Kaustubh Ahuja
- Department of Orthopaedics, All India Institute of Medical
Sciences, Rishikesh, India
| | | | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical
Sciences, Rishikesh, India
| | - Gagandeep Yadav
- Department of Orthopaedics, All India Institute of Medical
Sciences, Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical
Sciences, Rishikesh, India,Pankaj Kandwal, Department of Orthopaedics,
All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
| | - Bhaskar Sarkar
- Department of Orthopaedics, All India Institute of Medical
Sciences, Rishikesh, India
| | - Nikhil Goyal
- Department of Orthopaedics, All India Institute of Medical
Sciences, Rishikesh, India
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9
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Kim DH, Hyun SJ, Kim KJ. Selection of Fusion Level for Adolescent Idiopathic Scoliosis Surgery : Selective Fusion versus Postoperative Decompensation. J Korean Neurosurg Soc 2021; 64:473-485. [PMID: 34044493 PMCID: PMC8273784 DOI: 10.3340/jkns.2020.0258] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/09/2020] [Indexed: 11/27/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS), which is associated with an extensive range of clinical and radiological presentations, is the one of the most challenging spinal disorders. The goals of surgery are to correct the deformity in 3 dimensions and to preserve motion segments while avoiding complications. Despite the ongoing evolution of classification systems and algorithms for the surgical treatment of AIS, there has been considerable debate regarding the selection of an appropriate fusion level in AIS. In addition, there is no consensus regarding the exact description, relationship, and risk factors of coronal decompensation following selective fusion. In this review, we summarize the current concepts of selection of the fusion level for AIS and review the available information about postoperative coronal decompensation.
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Affiliation(s)
- Do-Hyoung Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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10
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Garcia EB, Garcia LF, Garcia Júnior EB, Sá AD, Matos VDO, Camarinha JG, Camarinha MF, Gonçalves RG, Garcia EB, Giesbrecht ST. COMPARATIVE STUDY OF THE TYPES OF FIXATION IN ADOLESCENT IDIOPATHIC SCOLIOSIS. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212001232530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To conduct a comparative study of the results obtained in the treatment of adolescent idiopathic scoliosis (AIS) with different types of fixations (traditional, selective and multiple), and to evaluate the correction of angular deformity in the frontal plane by the Cobb and sacral clavicular angle (SCA) methods. Methods: A study of a group of 278 patients with AIS who underwent selective, traditional, and multiple fixation surgeries. Results: Significant corrections of both the Cobb angle and the SCA were observed. Conclusions: In the multiple fixation surgeries there was a 100% correction between the preoperative and postoperative SCA values and a 50% correction in the traditional and selective fixations, a difference considered significant. Regarding the Cobb angle, the three fixations presented corrections between preop and postop with significant differences. Level of evidence III; Retrospective Study.
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Affiliation(s)
- Enguer Beraldo Garcia
- Santa Casa de Belo Horizonte, Brazil; Instituto da Coluna Vertebral de Belo Horizonte, Brazil; Sociedade Brasileira de Coluna, Brazil; Universidade Federal de Minas Gerais, Brazil
| | - Liliane Faria Garcia
- Santa Casa de Belo Horizonte, Brazil; Instituto da Coluna Vertebral de Belo Horizonte, Brazil
| | | | | | | | | | | | | | - Eduardo Beraldo Garcia
- Santa Casa de Belo Horizonte, Brazil; Instituto da Coluna Vertebral de Belo Horizonte, Brazil
| | - Saulo Terror Giesbrecht
- Santa Casa de Belo Horizonte, Brazil; Instituto da Coluna Vertebral de Belo Horizonte, Brazil
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11
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Spinal balance and lumbar curve stability after selective thoracic fusion in idiopathic scoliosis. Spine Deform 2021; 9:471-480. [PMID: 33118150 DOI: 10.1007/s43390-020-00229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Selective thoracic fusion (STF) for double curve patterns in idiopathic scoliosis is an attractive treatment option. However, short-term coronal decompensation and truncal imbalance are known findings. Previous studies with hook constructs showed that eventually balance is achieved via an increase in lumbar curve magnitude, as the lumbosacral obliquity did not change following surgery. Our aim is to investigate patients with idiopathic curves who underwent STF using all-pedicle screw constructs to determine if the uninstrumented lumbar curve and lumbosacral obliquity responded in the same manner as was previously reported with all-hook constructs. METHODS 102 consecutive patients with Lenke 1B, 1C or 3C curves who underwent STF using all-screw constructs at a single institution were included in this study. Radiographic assessment was performed, and patient reported outcomes were obtained. Subgroup analyses were performed based on preoperative thoracic: lumbar curve ratio as well as lumbar curve magnitude. RESULTS Overall, the patients showed statistically significant improvement in both trunk shift and L4-pelvis obliquity at final follow-up. The uninstrumented lumbar curves trended toward improvement over time, but did not reach statistical significance (p = 0.107). SRS-30 scores were statistically significantly improved in multiple domains. CONCLUSION Selective thoracic fusion is an excellent treatment option in most double curve patterns. Balance in the coronal plane is predictably achieved at 2-year follow-up. The lumbosacral obliquity improves more with screw technology than was previously found with hook constructs; therefore, the improvement in balance over time does not depend upon an increase in the uninstrumented lumbar curve. LEVEL OF EVIDENCE IV.
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Wang Y, Shi B, Liu Z, Sun X, Qiao J, Wang B, Qiu Y, Zhu Z. The Upper Instrumented Vertebra Horizontalization: An Essential Factor Predicting the Spontaneous Correction of Compensatory Curve After Lumbosacral Hemivertebra Resection and Short Fusion. Spine (Phila Pa 1976) 2020; 45:E1272-E1278. [PMID: 32453244 DOI: 10.1097/brs.0000000000003570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To determine the significance of postoperative upper instrumented vertebra (UIV) horizontalization on the evolution of proximal compensatory curve after hemivertebra resection and short fusion in young patients with lumbosacral hemivertebra (LSHV). SUMMARY OF BACKGROUND DATA Postoperative compensatory curve progression (CCP) is an undesired complication in patients undergoing spinal fusion. Posterior-only hemivertebra resection and short fusion has gradually become a preferred treatment for young patients with LSHV. Postoperative UIV horizontalization might play an important role in the behavior of compensatory curve after surgery. METHODS This study reviewed a consecutive series of patients undergoing posterior-only LSHV resection and short fusion from August 2006 to June 2016. The radiographic parameters were measured at preoperation, immediately postoperation, and the last follow-up. Based on the immediately postoperative UIV tilt, patients were divided into horizontal group (UIV tilt < 5°) and inclined group (UIV tilt ≥5°). Postoperative CCP was defined as the Cobb angle of compensatory curve increased more than 10° than the immediately postoperative value. RESULTS Forty-eight patients (8.1 ± 3.4 yrs) were recruited. Seventeen patients with immediately postoperative UIV tilt more than or equal to 5° constituted the inclined group, while the other 31 patients were in horizontal group. The two groups had similar age, fusion levels, preoperative spinal curvatures, and sagittal profiles. Compared with horizontal group, patients in inclined group had greater CBD (20.7 ± 14.8 mm vs. 13.2 ± 9.9 mm, P = 0.041) and greater Cobb angle of compensatory curve (17.7 ± 8.2° vs. 9.1 ± 5.3°, P < 0.001) at the last follow-up. Thirteen patients of inclined group experienced postoperative CCP, which was more prevalent than that in horizontal group (76.5% vs. 9.7%, P < 0.001). CONCLUSION Horizontalizing the UIV can reduce the risk of postoperative CCP in LSHV patients undergoing posterior-only hemivertebra resection and short fusion. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Yu Wang
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Benlong Shi
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhen Liu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jun Qiao
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Bin Wang
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
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Immediate postoperative coronal imbalance in Lenke 5 and Lenke 6 adolescent idiopathic scoliosis: Is it predictable? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2042-2052. [DOI: 10.1007/s00586-019-06019-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/10/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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Ishikawa M, Nishiyama M, Kamata M. Selective Thoracic Fusion for King-Moe Type II/Lenke 1C Curve in Adolescent Idiopathic Scoliosis: A Comprehensive Review of Major Concerns. Spine Surg Relat Res 2019; 3:113-125. [PMID: 31435563 PMCID: PMC6690091 DOI: 10.22603/ssrr.2018-0047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/25/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Controversies still exist in the surgical indications and outcomes of selective thoracic fusion (STF) for a primary thoracic curve with a compensatory large lumbar curve (King-Moe type II/Lenke 1C curve) in adolescent idiopathic scoliosis (AIS). Issues of the greatest concern regarding this curve type include curve criteria that indicate STF to prevent postoperative coronal decompensation and postoperative radiographic outcomes, including curve correction, coronal balance, and thoracolumbar kyphosis, after STF. METHODS This review comprehensively documents the issues raised in the literature regarding surgical indications and radiographic outcomes of STF for King-Moe type II/Lenke 1C curve in AIS. RESULTS Studies suggest that radiographic curve criteria indicating STF for this curve type include the preoperative dominance of the thoracic curve to the lumbar curve in the Cobb angle and the characteristics of the lumbar curve in magnitude and flexibility. Studies warn the need for a careful clinical evaluation of the thoracic and lumbar rotational prominences. Documented radiographic outcomes of importance include the postoperative behavior of the unfused lumbar curve, coronal or sagittal decompensation after STF, and factors associated with these issues. A comprehensive review of the literature suggests that the use of a segmental pedicle screw construct and better instrumented thoracic curve correction achieve better spontaneous lumbar curve correction. Although the causes of postoperative coronal decompensation remain multifactorial, preoperative coronal decompensation to the left and an inappropriate selection of the lowest instrumented vertebra are consistently reported to be the major causative factors. CONCLUSIONS STF has been validated in general for the treatment of King-Moe type II or Lenke 1C curve in AIS; however, controversies remain regarding the surgical indications and outcomes. Long-term impacts of residual lumbar curve, coronal decompensation, and mild thoracolumbar kyphosis on clinical outcomes after STF, along with optimal indications and strategy for STF, should further be assessed.
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Affiliation(s)
| | - Makoto Nishiyama
- Spine and Spinal Cord Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Michihiro Kamata
- Department of Orthopaedic Surgery, Keiyu Hospital, Kanagawa, Japan
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Coronal Imbalance after Selective Posterior Thoracic Fusion in Patients with Lenke 1 and 2 Adolescent Idiopathic Scoliosis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3476425. [PMID: 30627550 PMCID: PMC6304582 DOI: 10.1155/2018/3476425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022]
Abstract
Coronal decompensation is a common complication in Lenke 1 or 2 AIS patients after selective thoracic fusion (STF). However, the majority who developed immediately postoperative coronal decompensation experienced improvement and the related factors are not fully understood. The aim of this retrospective study was to investigate the prevalence of coronal imbalance in patients with Lenke 1 or 2 AIS and to explore radiological factors associated with spontaneous correction of coronal balance after surgery. Lenke 1 or 2 AIS patients receiving STF in our center from January 2013 to March 2015 were analyzed. Anteroposterior and lateral films were evaluated before surgery, at 1 month's and 2 years' follow-up. Patients were divided into 2 groups according to whether coronal imbalance occurred in the early postoperative period (1 month). Various radiological parameters as well as Scoliosis Research Society-22 were statistically compared between groups. Coronal decompensation was observed in 33 patients preoperatively, in 48 patients immediately postoperatively, and in 2 patients at final follow-up. Lowermost instrumented vertebra (LIV) disc angle (0.9° vs. 6.7°, p=0.019) and LIV- C7 plumb line and central sacral vertical line (CSVL) (-3.4mm vs. -13.7mm, p=0.020) increased in the final follow-up in the imbalanced group of type A modifier. The magnitude of lumbar curve was greater in the imbalanced group of type B or C modifier in the early postoperative period (19.5° vs. 12.6°, p=0.006; 25.5° vs. 13.7°, p<0.01), and this difference disappeared in the final follow-up. No differences in SRS-22 outcome scores were noted between groups in different time. Coronal imbalance was frequently detected immediately after STF in Lenke 1 or 2 AIS patients, with type C modifier slightly higher than A or B. Distal adding-on may help compensate for coronal imbalance in patients with type A modifier, while spontaneous correction of lumbar curve attributes to the improvement of coronal imbalance in patients with type B or C modifier.
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Kwan MK, Chiu CK, Tan PH, Chian XH, Ler XY, Ng YH, Ng SJ, Goh SH, Chan CYW. Radiological and clinical outcome of selective thoracic fusion for patients with Lenke 1C and 2C adolescent idiopathic scoliosis with a minimum follow-up of 2 years. Spine J 2018; 18:2239-2246. [PMID: 29733900 DOI: 10.1016/j.spinee.2018.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/19/2018] [Accepted: 05/01/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In Lenke 1C and 2C curves, the choice between selective thoracic fusion (STF) versus non-selective thoracic fusion as the optimal surgical treatment is controversial. OBJECTIVE This study aimed to assess the radiological and clinical outcome of patients with Lenke 1C and 2C curves treated with STF. STUDY DESIGN This is a retrospective study. PATIENT SAMPLE A total of 44 patients comprised the study sample. METHODS Forty-four patients with Lenke 1C and 2C curves with adolescent idiopathic scoliosis who underwent STF were reviewed. Radiological parameters and Scoliosis Research Society (SRS)-22r scores were assessed preoperatively, postoperatively, and on final follow-up. The incidence of coronal decompensation, lumbar decompensation, and adding-on phenomenon were reported. RESULTS Mean follow-up duration was 45.1±12.3 months and mean age was 17.0±5.1 years. The preoperative middle thoracic and thoracolumbar/lumbar (MT:TL/L) Cobb angle ratio was 1.4±0.3 and the MT:TL/L apical vertebra translation (AVT) ratio was 1.6±0.8. Final follow-up coronal balance was -13.0±11.5 mm, main thoracic AVT was 6.9±11.8 mm, and lumbar AVT was -20.4±13.8 mm (p<.05). Lumbar Cobb angle improved from 47.5°±7.8° to 24.9°±8.2° after operation and 23.3°±9.8° at final follow-up. The spontaneous lumbar curve correction rate was 50.9%. There were 9 patients (20.5%) who had coronal decompensation, 4 patients (9.1%) who had lumbar decompensation, and 11 patients (25.0%) who had adding-on phenomenon. We did not perform any revision surgery. The SRS-22r scores improved significantly in the overall scores, self-image, and mental health domain. CONCLUSIONS Selective thoracic fusion led to improvement in the radiological and clinical outcome for patients with Lenke 1C and 2C. Although no patients required revision surgery, the rate of coronal decompensation, lumbar decompensation, and adding-on phenomenon are significant.
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Affiliation(s)
- Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Pheng Hian Tan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Xue Han Chian
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Xin Yi Ler
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yun Hui Ng
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sherwin Johan Ng
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Saw Huan Goh
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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