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Topic:

Adolescent Idiopathic Scoliosis

Issue:

Spine

Category:

​

Title:

Breaking the Rules in Three Dimensions: What to Expect After a Thoracic-only Fusion With Structural Thoracic and Thoracolumbar Curves

Author:

Catanzano, Anthony MD; Upasani, Vidyadhar V. MD; Bryan, Tracey P. MA; Yaszay, Burt MD; Newton, Peter O. MD; Harms Study Group Collaborators

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p e242-e248, DOI: 10.1097/BPO.0000000000002591

Level Of Evidence:

IV

# of Patients:

22

Study Type:

Prospective study

Location:

Not specified

Summary:

This study assesses the outcomes of thoracic-only fusion in adolescent idiopathic scoliosis patients with double or triple major curves, focusing on radiographic and clinical outcomes at 2 years postoperatively.

Methods:

Participants: Patients with double or triple major curves undergoing thoracic-only posterior fusion, with a minimum 2-year follow-up. Radiographic Analysis: 3D reconstructions from bi-planar radiographs to assess changes in coronal, sagittal, and axial planes. Statistical Analysis: Paired sample t-tests to compare preoperative and postoperative data; Pearson correlations to identify factors affecting lumbar derotation.

Exclusions:

Not specified

Results:

Coronal Plane Improvement: Both thoracic (61 ± 10 degrees to 20 ± 9 degrees) and lumbar curves (41 ± 7 degrees to 22 ± 7 degrees) showed significant coronal correction (P < 0.001). Kyphosis: T5 to T12 kyphosis improved significantly (7 ± 14 degrees to 23 ± 8 degrees, P < 0.001). Translation: Thoracic apical translation improved (4.7 ± 1.5 cm to 0.5 ± 1 cm, P < 0.001), but lumbar apical translation remained unchanged (−1.7 ± 0.6 cm to −1.7 ± 0.8 cm, P = 0.94). SRS-22 Scores: Significant improvement in patient-reported outcomes by 2 years postoperative.

Conclusions:

Thoracic-only fusion in patients with double or triple major scoliosis curves resulted in spontaneous correction of the lumbar curve in the coronal plane, but no significant improvements in the sagittal or axial planes. These radiographic changes did not negatively affect clinical outcomes, and significant improvements in patient-reported quality of life were observed at the 2-year follow-up.

Relevance:

Limitations:

Perspective:

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