Predictors of spontaneous lumbar curve correction in thoracic-only fusions: 3D analysis in AIS

To evaluate how 3D parameters of the instrumented thoracic spine relate to the uninstrumented lumbar spine following thoracic-only fusion (TOF) for adolescent idiopathic scoliosis (AIS) and determine the factors predictive of lumbar correction.

A multi-center retrospective review was conducted of AIS patients with Lenke 1-4 B or C curves undergoing fusion of their thoracic spine only with minimum 2-year follow-up and 3D spine reconstructions from biplanar radiography. Pre-operative to 2-year post-operative differences were evaluated. Pearson's correlations were used to identify 3D coronal, sagittal and axial relationships at 2 years post-operative. Multivariate linear regression was used to identify variables most predictive of lumbar curve correction.

Eighty-four AIS patients met inclusion (54 B modifiers, 30 C modifiers). Average pre-operative thoracic and lumbar curves were 54 ± 9° and 41 ± 7° and corrected to 19 ± 7° and 21 ± 7°, respectively. 3D T5-T12 thoracic kyphosis increased from 6 ± 13° to 26 ± 8°. Thoracic and lumbar apical rotation decreased from - 14 ± 6° to -5 ± 6° and 13 ± 5° to 11 ± 6°, respectively. Thoracic curve correction correlated with lumbar curve correction (r = 0.67, p = 0.001) and decreased LIV tilt correlated with smaller residual lumbar curve magnitude (r = 0.63, p < 0.001). Increasing 3D kyphosis of the instrumented segment correlated with increased percentage lumbar curve correction (r = 0.29, p = 0.009). Multivariate linear regression showed LIV tilt and thoracic curve magnitude as the most predictive variables of post-operative residual lumbar curve magnitude, and percent correction of the thoracic curve and change in 3D instrumented kyphosis as most predictive of percent correction of the lumbar curve.

Analysis of 3D data highlights several considerations for AIS patients undergoing TOF. Maximizing thoracic curve correction, leveling the LIV, and to a lesser extent, restoring kyphosis in the instrumented segment are the factors most likely to result in greater correction of the instrumented lumbar curve following thoracic-only fusions in Lenke 1-4 B and C curves.