Spontaneous lumbar curve correction in selective anterior instrumentation and fusion of idiopathic thoracic scoliosis of Lenke type C

• Published in: European spine journal 2013-03, Vol.22 (Suppl 2), p.138-148
• Main Authors: Liljenqvist, Ulf, Halm, Henry, Bullmann, Viola
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Humans; Internal Fixators; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Medicine; Medicine & Public Health; Neurosurgery; Original; Original Article; Radiography; Scoliosis - diagnostic imaging; Scoliosis - surgery; Spinal Fusion - instrumentation; Spinal Fusion - methods; Surgical Orthopedics; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; Treatment Outcome; Young Adult
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-012-2299-7

Background Posterior pedicle screw instrumented correction and fusion have become the gold standard in the surgical treatment of thoracic scoliosis. However, in thoracic Lenke type C curves selective posterior fusion of the thoracic curve may lead to spinal imbalance. The aim of the study was to analyse the radiological results of selective anterior thoracic fusion using a standard open dual rod technique with special respect to spontaneous lumbar curve correction (SLCC). Methods Twenty-eight patients (26 patients with Lenke 1C and 2 patients with Lenke 2C curves) with an average age of 15 years were surgically treated with an anterior dual rod system through a standard open double thoracotomy approach. Average clinical and radiological follow-up was 4 years (24–84 months). Results Fusion was carried out mostly from end-to-end vertebra. The primary curve was corrected from 61.6° (average correction on reverse bending films 42.9 %) to 27.1° (56.0 % correction) with an average loss of correction of 2.2°. The secondary lumbar curve measured 47.7° preoperatively (40–56°, average correction on reverse bending films 66.2 %) and corrected spontaneously to 30.1° (36 % SLCC) and remained stable without any cases of deterioration or decompensation during follow-up. Lumbar apical vertebral translation increased minimally by an average of 4 mm directly, postoperatively, and returned to an average of preoperative values during follow-up. All but two curves remained as type C lumbar modifier at follow-up. Preoperatively, three patients showed a marked coronal imbalance of more than 3 cm (all left, average 4.0 cm); at follow-up, two patients were still out of balance by more than 3 cm (all to the left, average 3.4 cm). Preoperatively, a marked shoulder imbalance of more than 1.0 cm was found in 11 patients; this was corrected in all patients to