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Surgical video - technical nuances of performing a selective thoracic fusion for a Lenke 1B adolescent scoliotic
Daniel Faraj1, Henry Forbes Fowler1, Michael Galgano1
1Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, United States.
Background:
Adolescent idiopathic scoliosis (AIS) often mandates surgical management, with posterior fusion and pedicle screw constructs being the standard approach. Lenke 1B curve patterns have seen success with selective thoracic fusion, preserving lumbar function and avoiding a longer fusion construct. Our high-definition operative video details key steps of successfully performing a selective thoracic fusion for the correction of a Lenke 1B curve.
Case Description:
Preoperative imaging was significant for right coronal offset, a 62° main thoracic curve, as well as thoracic hypokyphosis. T3-L1 posterior instrumented fusion with multiple posterior column osteotomies was performed. Considerations including skeletal maturity and alternative treatment options are discussed. Rationale of key maneuvers such as performing inferior articular dissection before pedicle screw placement, mitigation of spinal canal injury during concave pedicle screw placement, and differential rod contouring are all thoroughly highlighted.
Conclusion:
Selective thoracic fusion for Lenke 1B AIS can achieve robust coronal correction while preserving lumbar mobility. This surgical video highlights the critical technical nuances for this technique as well as patient-specific considerations that inform surgical decision-making and execution in this patient population.
