Selective thoracic fusion preserved more lumbar motion than nonselective fusion in adolescent idiopathic scoliosis patients with Lenke C-type lumbar curves, but it left larger residual curves and lower self-image gains at 10 years, according to a Sept. 14 Harm Study Group research published in Spine Deformity.
The study, led by Nicholas Fletcher, MD, medical director of the spine program at Children’s Healthcare of Atlanta’s Orthopedic and Sports Medicine Center, is the first to evaluate clinical, radiographic and patient-reported outcomes of selective thoracic fusion at 10-year follow-up.
The researchers followed 97 patients for at least 10 years after surgery: 45 who underwent selective thoracic fusion, stopping at L1 or above, and 52 who underwent nonselective fusion of both curves, extending to L2 or below.
At 10 years, nonselective fusion patients had smaller residual lumbar curves, 17 degrees vs. 23 degrees, but less lateral bending. Forward flexion showed no difference between groups.
More nonselective fusion patients reached a clinically meaningful improvement in self-image on the Scoliosis Research Society-22 patient-reported outcomes survey, 83% vs. 60%. The groups showed no difference in any other SRS-22 domain.
Complication and reoperation rates did not differ between the techniques. The nonselective fusion group started with larger main thoracic and thoracolumbar curves before surgery.
The authors noted that the trade-off between preserved motion on one hand and greater correction and self-image gains on the other gives surgeons and families meaningful data for surgical decision-making.
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