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Comparison of Radiologic and Clinical Results of Short-Long Level Posterior Fusion in Lenke Type 5C Scoliosis
Süleyman K Taş1, Abdurrahman Aydın2, Cem Yetkin3
1Department of Orthopedics and Traumatology, Gumushane State Hospital, Gumushane, Turkey.
Background:
Lenke type 5C scoliosis is treated surgically with long-segment (nonselective) or short-segment (selective) level fusion. For Lenke type 5C scoliosis, no standardized criteria exist for selecting proximal and distal fusion levels. Studies report that short-segment level fusion patients with correct patient selection have a direct effect on the result of a well-balanced spine.
Purpose:
To compare the midterm and long-term radiologic and clinical outcomes of short-segment (selective) vs long-segment (nonselective) fusion in Lenke type 5C scoliosis.
Design:
Retrospective cohort study.
Patient Sample:
This retrospective study evaluated patients who underwent posterior instrumentation for Lenke type 5C adolescent idiopathic scoliosis (AIS) at our institution between 2005 and 2016.
Outcome Measure:
Physiologic measures: radiological evaluations included coronal, sagittal, and spinopelvic balance assessments as well as shoulder balance parameters on X-ray. Functional measures: clinical evaluations were performed using the SF-36 and SRS-22(r) scores.
Methods:
Patients with Lenke type 5C scoliosis who underwent selective (group 1) or nonselective (group 2) instrumentation were retrospectively analyzed. Group 1 included 47 patients (42 females and five males) with a mean age of 16.1 ± 2.4 year (range, 12-22), and group 2 included 58 patients (53 females and five males) with a mean age of 16.3 ± 3.4 yr (range, 12-24; P > .05). Radiological evaluations included coronal, sagittal, and spinopelvic balance assessments, as well as shoulder balance parameters. Clinical evaluations were performed using SF-36 and SRS-22(r) scores; results were compared between the two groups.
Results:
Both groups exhibited similar results in terms of coronal, sagittal, and spinopelvic balance as well as shoulder balance in many data after surgery (P > .05). Clinical outcomes, assessed via SF-36 mental health and SRS-22(r) scores, did not show statistically significant differences between groups (P > .05), except fort the physical role difficulty domain of the SF-36, where the selective fusion group (77.1 ± 31.6) showed significantly better scores than nonselective group (58.2 ± 36.1). However, the mean surgical time and transfusion requirement were significantly lower in the selective fusion group.
Conclusion:
When appropriately applied, selective fusion achieves comparable radiologic and clinical outcomes to nonselective fusion, with the added advantages of shorter surgical time and lower transfusion requirements.
Key Concepts:
(1)Selective fusion, when performed in appropriately selected patients, was found to be as stable as nonselective fusion in terms of shoulder balance, coronal balance, sagittal balance, and spinopelvic parameters.(2)Selective fusion offers several advantages, including shorter operative time, reduced blood loss, shorter hospital stays, and lower patient-based costs.(3)Lenke type 5 selective fusion has high stability within the right patient selection.
Level Of Evidence:
Level III Case-control study or retrospective cohort study.
