Long-Term Follow-Up Case SeriesSelective Thoracic Fusion Provides Similar Health-Related Quality of Life but Can Cause More Lumbar Disc and Facet Joint Degeneration: A Comparison of Adolescent Idiopathic Scoliosis Patients With Normal Population 10 Years After Surgery
Introduction
The goals of surgical treatment in adolescent idiopathic scoliosis (AIS) are to provide a balanced spine over the pelvis while preserving motion in the segments as distal as possible, improve cosmesis, and prevent back pain and cardiorespiratory failure [1], [2], [3], [4].
Selective thoracic fusion (STF) for the treatment of adolescent idiopathic scoliosis preserves lumbar motion segments but leaves a residual deformity that can show different behaviors in the early and late postoperative periods. By avoiding fusion of the lumbar spine, a greater mobility may be preserved, and the surgical exposure is reduced [5], [6].
Selective thoracic fusion was first described by Von Lackum in 1949 [7]. He performed fusion of the primary curve alone without instrumentation for flexible single primary thoracic curves and reported successful correction of compensatory curves. He specifically emphasized that overcorrection of the primary curve resulted in subsequent loss of balance in his series. In 1983, King et al.[8] introduced King−Moe classification and described the selective thoracic fusion criteria, especially for Type II curves (major thoracic curve with compensatory lumbar curve).
Although the King−Moe system has been the gold standard for classification of AIS in late 1980s, in subsequent years occasional cases of postoperative coronal decompensation were reported in patients with Type II curves who were managed with segmental spinal instrumentation and selective thoracic fusion. Inappropriate curve selection and/or excessive thoracic correction were identified as the most common etiologies [9], [10], [11], [12].
In 2001, Lenke et al. [13] described a new surgical classification system for AIS and recommended selective thoracic fusion for Type 1C, Type 2C, and some Type 3C curves [14].
The number of long-term follow-up studies in the literature about selective thoracic fusion is limited. These studies mainly focused on radiologic progression of nonfused lumbar curve and clinical results, including pain and disability scores [15], [16], [17].
To our knowledge, there is no study in the current literature that evaluated the unfused lumbar curve after selective thoracic fusion with MRI study in terms of facet and disc changes together in long-term follow-up.
The purpose of this study is to evaluate the long-term behavior of the lumbar curve in patients with adolescent idiopathic scoliosis (Lenke Type 1B and 1C) treated with selective thoracic fusion and to assess the clinical and radiologic outcomes in this fusion group compared with an age- and gender-matched population group. This study will help to define the natural history of the lumbar spine after STF and demonstrate any relationship between radiographic evidence of degenerative changes and clinical factors with validated outcome measures.
Section snippets
Materials and Methods
We retrospectively reviewed all the AIS cases surgically treated in our institution from 1996 to 2004. Collection and analysis of radiographic and clinical data were performed. A total of 157 AIS patients with Lenke Type 1 curve were operated at our institution. There were 53 patients with Lenke Type 1B curve and 39 patients with Lenke Type 1C curve who had STF surgery for AIS. Among these patients, 37 Lenke Type 1B and 28 Lenke Type 1C patients had full follow-up radiographs. Although these
Results
A total of 25 patients (24 female and 1 male) who had full follow-up radiographs and lumbar MRI scan after minimum 10 years' follow-up were included in this study group (Group A). The mean age was 23.8 years (range = 21–30). The mean duration of follow-up was 11.4 years (range = 10–18). The control group (Group B) included 30 asymptomatic individuals (29 female and 1 male) without any spinal deformity. The mean age was 24.2 years (range = 20–29).
Curve types according to Lenke system in group A
Discussion
Biomechanical studies on the behavior of fused spinal segments suggest that motion segments immediately adjacent to a long fusion will sustain increased stresses and pathologic increases in range of motion. Increased stress at adjacent unfused levels will lead accelerated progression of normal degenerative changes. During the evolution of the AIS surgery, this concept has driven innovation to develop techniques limiting the number of fusion levels [18]. Satisfactory spontaneous lumbar curve
References (32)
- et al.
Harrington instrumentation and arthrodesis for idiopathic scoliosis. A twenty-one-year follow-up
J Bone Joint Surg Am
(1990) - et al.
Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study—part II
Spine (Phila Pa 1976)
(2003) - et al.
Long-term health-related quality of life after surgery for adolescent idiopathic scoliosis and spondylolisthesis
J Bone Joint Surg Am
(2008) - et al.
Low back pain in patients treated surgically for scoliosis: longer than sixteen-year follow-up
Spine (Phila Pa 1976)
(2009) - et al.
Factors involved in the decision to perform a selective versus non-selective fusion of Lenke 1B and 1C (King-Moe II) curves in adolescent idiopathic scoliosis
Spine (Phila Pa 1976)
(2003) - et al.
Selective posterior thoracic fusions for adolescent idiopathic scoliosis
Spine (Phila Pa 1976)
(2006) - et al.
Critical observations of the results in the operative treatment of scoliosis
J Bone Joint Surg Am
(1949) - et al.
The selection of fusion levels in thoracic idiopathic scoliosis
J Bone Joint Surg Am
(1983) - et al.
Coronal decompensation produced by Cotrel-Dubousset “derotation” maneuver for idiopathic right thoracic scoliosis
Spine (Phila Pa 1976)
(1991) - et al.
Preventing decompensation in King type II curves treated with Cotrel-Dubousset instrumentation: strict guidelines for selective thoracic fusion
Spine (Phila Pa 1976)
(1992)
Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King II curve pattern: review of 67 consecutive cases having selective thoracic arthrodesis
Spine (Phila Pa 1976)
A meta-analysis of the literature on the issue of selective thoracic fusion for the King-Moe type II curve pattern in adolescent idiopathic scoliosis
Spine (Phila Pa 1976)
Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis
J Bone Joint Surg Am
The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine
Spine (Phila Pa 1976)
Selective thoracic fusion for adolescent idiopathic scoliosis with C modifier lumbar curves: 2- to 16-year radiographic and clinical results
Spine (Phila Pa 1976)
Predicting the outcome of selective thoracic fusion in false double major lumbar “C” cases with five- to twenty-four-year follow-up
Spine (Phila Pa 1976)
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Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis: Long-Term Radiographic and Functional Outcomes*
2018, Spine DeformityCitation Excerpt :Spontaneous lumbar curve correction has been observed with an STF, and short-term results have shown curve correction maintenance [3-7], with long-term studies including STF cases in the review of the outcome of fusion for AIS [8,9]. There are three long-term studies of STF cases with a span of 7–20 years that report good outcomes [3,10,11]. This study was undertaken to investigate the long-term results of STF to answer the following three questions.
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Author disclosures: ME (none); SiK (none); MC (none); SY (none); BHG (none); SeK (none); AM (none); LOU (none); CO (reports nonfinancial support from Medtronic, outside the submitted work); EE (none); EG (none); TS (none); AA (reports nonfinancial support from Medtronic, nonfinancial support from DePuy-Synthes, outside the submitted work); AH (reports nonfinancial support from Medtronic, outside the submitted work)
This study was performed at the Istanbul Spine Center, Florence Nightingale Hospital, Istanbul, Turkey.