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Selective thoracic fusion of a left decompensated main thoracic curve: proceed with caution?

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Abstract

Purpose

Previous research has shown that with certain idiopathic scoliosis curve types, performing a selective thoracic fusion (STF) is associated with an increased risk of coronal decompensation post-operatively. The purpose of the current study was to determine the influence of curve correction and fusion level on post-operative balance in STF for adolescent idiopathic scoliosis patients with pre-operative coronal decompensation.

Methods

A multicenter database was queried for subjects with right Lenke 1–4C curves, pre-operative left coronal imbalance, and 2-year follow-up who underwent STF (caudal fusion level of L1 or proximal). Rates of decompensation were compared between groups with different levels of fusion. Thoracic and lumbar curve correction as well as Scoliosis Research Society-22 outcome scores were compared between groups that were post-operatively balanced or persistently decompensated.

Results

121 patients were identified with average thoracic and lumbar curves of 53° and 41°. Mean pre- and post-operative decompensations were 2.4 ± 1.0 and 1.8 ± 1.1 cm, respectively. Eighteen patients were fused short, 62 to, and 41 were fused past the stable vertebra. Ten patients were fused short, 32 to, and 78 were fused past the neutral vertebra. Incidence of post-operative decompensation was 41%. No differences in post-operative decompensation relative to the stable or neutral vertebra were noted (p = 0.66, p = 0.74). Post-operatively, those patients who were balanced had similar thoracic curve correction (58%) to those decompensated (54%, p = 0.11); however, patients balanced post-operatively had greater SLCC (45 vs 40%, p = 0.04). No differences in SRS-22 outcome scores were noted between groups (p > 0.05).

Conclusions

There was a high rate of post-operative decompensation in patients with pre-operative coronal decompensation undergoing STF. Fusion to or past the stable or neutral vertebra did not affect the risk of persistent decompensation. Attempts to improve SLCC could reduce post-operative decompensation.

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Acknowledgements

This study was supported in part by funding from DePuy Synthes Spine to Setting Scoliosis Straight Foundation.

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Authors and Affiliations

  1. University of California, San Diego, CA, USA

    T. Barrett Sullivan

  2. Rady Children’s Hospital, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Tracey P. Bastrom, Carrie E. Bartley, Peter O. Newton & Burt Yaszay

  3. Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA

    Suken A. Shah

  4. Mount Sinai Hospital, New York, NY, USA

    Baron S. Lonner

  5. Nicklaus Children’s Hospital, Miami, FL, USA

    Jahangir Asghar

  6. BC Children’s Hospital, Vancouver, BC, Canada

    Firoz Miyanji

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  1. T. Barrett Sullivan
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Correspondence to Burt Yaszay.

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All authors declared that they have no potential conflict of interest.

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IRB approval was received for this study.

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Sullivan, T.B., Bastrom, T.P., Bartley, C.E. et al. Selective thoracic fusion of a left decompensated main thoracic curve: proceed with caution?. Eur Spine J 27, 312–318 (2018). https://doi.org/10.1007/s00586-017-5158-8

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  • DOI: https://doi.org/10.1007/s00586-017-5158-8

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