Criteria for Selective Fusion in Idiopathic Scoliosis Using Cotrel-Dubousset Instrumentation

McCall, Richard E.; Bronson, William

doi:10.1097/01241398-199207000-00011

Cited by 71 publications

(34 citation statements)

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“…Roye et al [51] also reported significantly less correction of the lumbar curves than of the thoracic curves (38 compared to 50%, respectively). Lumbar curve magnitude or stiffness also correlates to decreased correction of the lumbar curve and lumbar curve decompensation [30,52]. As a result of these and other studies, the preoperative push-prone and supine lumbar radiographs were recommended as the best assessment of pre-operative flexibility imaging to predict the ideal amount of thoracic curve correction and expected spontaneous lumbar curve correction [53].…”

Section: The Amount Of Correction For Selective Thoracic Fusionmentioning

confidence: 99%

“…Poor outcomes are related with progression of the unfused lumbar curve below a selective fusion [42,43], overcorrection of the thoracic curve [30,44,45], poor choice of fusion levels [42,47,56,57], incorrect identification of curve patterns [30,58], lumbar curve magnitude or stiffness [30,52], and relative position and rotation of the apical vertebrae [30,59]. In a study following patient outcomes with a minimum 5 years follow-up after selective thoracic fusion, the overall revision rate to accommodate worsening deformity was 6% (2/32 patients) [60].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

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Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Fischer

Kim

2011

Eur Spine J

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Selective fusion of thoracic and thoracolumbar/ lumbar curves in adolescent idiopathic scoliosis is a concept critically debated in the literature. While some surgeons strongly believe that a more rigid and straighter spine provides predictably excellent outcomes, some surgeons recommend a mobile and less straight spine. This topic is a crucial part of surgical treatment of idiopathic scoliosis, particularly in young patients who will deal with the stress of the fusion mass at the proximal and distal junctions over many years. This study will review the literature on various aspects of selective fusion.

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Section: The Amount Of Correction For Selective Thoracic Fusionmentioning

confidence: 99%

Section: Postoperative Complicationsmentioning

confidence: 99%

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Fischer

Kim

2011

Eur Spine J

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“…7,8 Recent interest in determining risk factors for postoperative decompensation after STF has led to research attempting to elucidate criteria for predicting the optimal surgical strategy. Factors such as proper selection of the LIV, 1,3,4,24,29,31,37,[41][42][43] the main thoracic to thoracolumbar/lumbar (MT:TL/L) ratio, 25,28,34 thoracic "overcorrection," 5,6,12,13,16,17,19,25,45 and surgical approach have been correlated with risk of postoperative decompensation. Despite guidelines for performing STF, NSTF is still commonly performed, with one study showing only 49% of patients with Lenke 1C curves being treated with an STF.…”

mentioning

confidence: 99%

“…3,20,38,43 With the evolution of spinal instrumentation and surgical techniques, STF has been shown to provide successful correction of the thoracic curve with spontaneous correction of the uninstrumented lumbar curve to allow for a well-balanced postoperative spinal column; 5,6,23,32,34,36,40,42 however, the risk for coronal decompensation remains a concern. 1,13,14,24,28,29,31,32,43 The decision to include the lumbar compensatory curve by performing a nonselective thoracic fusion (NSTF) may provide a "safer" option in the context of preventing revision surgery for coronal decompensation. 32 However, it must be weighed against the risk of an increased likelihood of back pain and degenerative changes with a more distal fusion into the mid-and lower lumbar spine.…”

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confidence: 99%

Selective versus nonselective thoracic fusion in Lenke 1C curves: a meta-analysis of baseline characteristics and postoperative outcomes

Boniello¹,

Hasan²,

Sun³

et al. 2015

SPI

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OBJECT Lenke 1C curves are challenging to manage surgically due to the structural thoracic deformity and nonstructural lumbar curve. Selective thoracic fusion (STF) is considered the standard of care because it preserves motion of the lumbar segment, yet nonselective STF (NSTF) remains prevalent. This study aims to identify baseline patient characteristics that drive treatment and to compare postoperative outcomes for both procedures. METHODS Studies that compared baseline and postoperative demographic data, health-related quality of life (HRQL) questionnaires, and radiographic parameters of patients with Lenke 1C curves undergoing STF or NSTF were identified for meta-analysis. The effect measure is expressed as a mean difference (MD) with 95% CI. A positive MD signifies a greater STF value, or a mean increase within the group. RESULTS One prospective and 6 retrospective case-control studies with sample size of 488 patients (344 STF and 144 NSTF) were identified. Baseline age, sex, and HRQLs were equivalent, except for better scores in the STF group for the Scoliosis Appearance Questionnaire (SAQ): Unrelated to Deformity item (3.47 vs 3.88, p = 0.01) and the Spine Research Society questionnaire, Item 22: Pain (4.13 vs 3.92, p = 0.04). Radiographic findings were significantly worse in NSTF, as measured by the thoracolumbar/lumbar (TL/L) Cobb angle (MD: −4.29°, p < 0.01) and TL/L apical vertebral translation (AVT) (MD: −6.08, p < 0.01). Radiographic findings significantly improved in STF, as measured in the main thoracic (MT) Cobb angle (MD: −27.78°, p < 0.01), TL/L Cobb angle (MD: −16.24°, p < 0.01), MT:TL/L Cobb ratio (MD: −0.21, p < 0.01), coronal balance (MD: 0.47, p = 0.02), and thoracic kyphosis (MD: 7.87°, p < 0.01); and in NSTF in proximal thoracic (PT) Cobb angle (24° vs 14.1°, p < 0.01), MT Cobb angle (53.5° vs 20.5°, p < 0.01), and TL/L Cobb angle (41.6° vs 16.6°, p < 0.01). Postoperative TL/L Cobb angle (23.1° vs 16.6°, p < 0.01) was significantly higher in STF; but PT Cobb angle, MT Cobb angle, and MT:TL/L Cobb ratio are equivalent. CONCLUSIONS Patients with larger lumbar compensatory curves displaying a larger degree of coronal translation, as measured by the TL/L AVT, are more likely to undergo an NSTF. Contrary to established guidelines, larger MT curve magnitudes and MT:TL/L Cobb angle ratios have not been found to influence the decision to pursue a selective thoracic fusion. Although overall both STF and NSTF groups are found to have effective postoperative coronal balance, the STF group has only modest improvements in the lumbar curve position as determined by a relatively unchanged TL/L AVT. Furthermore, surgeons may prefer NSTF in patients who may have a worse overall perception of their spinal deformity as measured by HRQL measures of pain and desire for appearance change.

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“…Until now, supine side-bending has been considered the standard method for curve assessment and surgical decision-making [9,15]. However, some authors have suggested that the correlation of preoperative supine sidebending radiographs and postoperative curve correction is suboptimal [16][17][18], especially as pedicle screw utilization has become increasingly popular. An additional disadvantage of supine side-bending imaging is that it is not standardized.…”

Section: Discussionmentioning

confidence: 99%

Coronal deformity correction in adolescent idiopathic scoliosis patients using the fulcrum-bending radiograph: a prospective comparative analysis of the proximal thoracic, main thoracic, and thoracolumbar/lumbar curves

Dumonski

Samartzis

et al. 2010

Eur Spine J

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The aim of the prospective, comparative radiographic analysis was to determine the role of the fulcrum-bending radiograph (FBR) for the assessment of the proximal thoracic (PT), main thoracic (MT), and the thoracolumbar/lumbar (TL/L) curves in patients undergoing posterior spinal pedicle screw fixation and fusion for adolescent idiopathic scoliosis (AIS). The FBR demonstrated statistically better correction than other preoperative methods for the assessment of frontal plane correction of the MT curves. The fulcrum-bending correction index (FBCI) has been considered a superior method than the correction rate for comparing curve correction undergoing posterior spinal fusion because it accounts for the curve flexibility. However, their applicability to assess the PT and TL/L curves in AIS patients remains speculative. The relation between FBR and correction obtained by pedicle screws fixation is still unknown. Thirty-eight consecutive AIS patients who underwent pedicle screw fixation and posterior fusion were included in this study. The assessment of preoperative radiographs included standing posterior-anterior (PA), FBR, supine side-bending, and postoperative standing PA and lateral plain radiographs. The flexibility of the curve, as well as the FBCI, was calculated for all patients. Postoperatively, radiographs were assessed at immediate (i.e. 1 week), 3-month, 6-month, 12-month, and 2-year follow-up. Cobb angles were obtained from the PT, MT, and TL/L curves. The study consisted of 9 PT, 37 MT, and 12 TL/L curves, with a mean age of 15.1 years. The mean FBR flexibility of the PT, MT, and the TL/L curves was 42.6, 61.1, and 66.2%, respectively. The mean operative correction rates in the PT, MT, and TL/L curves were 43.4, 69.3, and 73.9%, respectively, and the mean FBCI was 103.8, 117.0, and 114.8%, respectively. Fulcrum-bending flexibility was positively correlated with the operative correction rate in PT, MT, and TL/ L curves. Although the correction rate in MT and TL/L curves was higher than PT curves, the FBCI in PT, MT, and TL/L curves was not significantly different (p \ 0.05). The FBR can be used to assist in the assessment of PT, MT, and TL/L curve corrections in AIS patients. When curve flexibility is taken into account by FBR, the ability of pedicle screws to correct PT, MT, and TL/L curves is the same.

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Criteria for Selective Fusion in Idiopathic Scoliosis Using Cotrel-Dubousset Instrumentation

Cited by 71 publications

References 0 publications

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Selective versus nonselective thoracic fusion in Lenke 1C curves: a meta-analysis of baseline characteristics and postoperative outcomes

Coronal deformity correction in adolescent idiopathic scoliosis patients using the fulcrum-bending radiograph: a prospective comparative analysis of the proximal thoracic, main thoracic, and thoracolumbar/lumbar curves

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