Jie Li1, Zhihui Zhao1, Changchun Tseng1, Zezhang Zhu1, Yong Qiu1, Zhen Liu2. 1. Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China. 2. Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China. Electronic address: drliuzhen@163.com.
Abstract
OBJECTIVE: To compare the clinical and radiographic outcomes on the sagittal plane between anterior and posterior selective fusion (ASF and PSF) in patients with Lenke 5 adolescent idiopathic scoliosis (AIS) for a minimum of 5 years of follow-up. METHODS: We included 77 patients with Lenke 5 AIS who underwent ASF (n = 40) with a single rod with structural cages or PSF (n = 37) with pedicle screw instrumentation. Radiographic parameters were compared preoperatively, 3 months and 2 years postoperatively, and at final follow-up. RESULTS: The mean follow-up duration was 93.9 ± 21.4 months in the ASF group and 80.4 ± 15.2 in the PSF group (P = 0.002). The correction rate of the coronal curve was comparable between the 2 groups at final follow-up. There was a significant time trend for lumbar lordosis (LL), thoracic kyphosis, thoracolumbar junctional kyphosis, instrumented segmental angle (ISA), proximal junctional angle, and sagittal vertical axis (P < 0.001) and significant group effects for LL (P = 0.0065) and ISA (P = 0.0325). At 3 months postoperatively, LL decreased in the ASF group and increased in the PSF group (-3.1° ± 6.6° vs. 1.3° ± 5.5° change, P = 0.002) and increased in both groups at final follow-up (2° ± 2.9° vs. 4.3° ± 4.9° change, P = 0.070). ISA increased in both groups 3 months postoperatively but decreased significantly in the ASF group compared with the PSF group at 2-year follow-up (4.0° ± 3.9° vs. 0.7° ± 1.9° change, P < 0.001) and final follow-up (8.1° ± 5.8° vs. 0.8° ± 3.4° change, P < 0.001). LL, ISA, and proximal junctional angle were significantly larger at final follow-up in the PSF group (P < 0.05). The incidence of proximal junctional kyphosis was higher in the PSF group (5/37) than in the ASF group (1/40). CONCLUSIONS: A significant and continuous loss of lordosis in ISA was observed after ASF in patients with Lenke 5 AIS. A larger LL was obtained with a higher incidence of proximal junctional kyphosis at long-term follow-up after PSF.
OBJECTIVE: To compare the clinical and radiographic outcomes on the sagittal plane between anterior and posterior selective fusion (ASF and PSF) in patients with Lenke 5 adolescent idiopathic scoliosis (AIS) for a minimum of 5 years of follow-up. METHODS: We included 77 patients with Lenke 5 AIS who underwent ASF (n = 40) with a single rod with structural cages or PSF (n = 37) with pedicle screw instrumentation. Radiographic parameters were compared preoperatively, 3 months and 2 years postoperatively, and at final follow-up. RESULTS: The mean follow-up duration was 93.9 ± 21.4 months in the ASF group and 80.4 ± 15.2 in the PSF group (P = 0.002). The correction rate of the coronal curve was comparable between the 2 groups at final follow-up. There was a significant time trend for lumbar lordosis (LL), thoracic kyphosis, thoracolumbar junctional kyphosis, instrumented segmental angle (ISA), proximal junctional angle, and sagittal vertical axis (P < 0.001) and significant group effects for LL (P = 0.0065) and ISA (P = 0.0325). At 3 months postoperatively, LL decreased in the ASF group and increased in the PSF group (-3.1° ± 6.6° vs. 1.3° ± 5.5° change, P = 0.002) and increased in both groups at final follow-up (2° ± 2.9° vs. 4.3° ± 4.9° change, P = 0.070). ISA increased in both groups 3 months postoperatively but decreased significantly in the ASF group compared with the PSF group at 2-year follow-up (4.0° ± 3.9° vs. 0.7° ± 1.9° change, P < 0.001) and final follow-up (8.1° ± 5.8° vs. 0.8° ± 3.4° change, P < 0.001). LL, ISA, and proximal junctional angle were significantly larger at final follow-up in the PSF group (P < 0.05). The incidence of proximal junctional kyphosis was higher in the PSF group (5/37) than in the ASF group (1/40). CONCLUSIONS: A significant and continuous loss of lordosis in ISA was observed after ASF in patients with Lenke 5 AIS. A larger LL was obtained with a higher incidence of proximal junctional kyphosis at long-term follow-up after PSF.
Authors: Takashi Hirase; Jeremiah F Ling; Varan Haghshenas; Jeyvikram Thirumavalavan; David Dong; Darrell S Hanson; Rex A W Marco Journal: Spine Deform Date: 2021-11-01