Turkish Neurosurgery 2023 , Vol 33 , Num 1
Does Thoracic Kyphosis Have any Importance in Selective Versus Nonselective Fusion Preference in Patients with Lenke Type 5C Adolescent Idiopathic Scoliosis?
Gokhan KARADEMIR1,Kerim SARIYILMAZ2,Mehmet DEMIREL3,Okan OZKUNT4,Fatih DIKICI2,Unsal DOMANIC3
1Acibadem Maslak Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
2Acibadem MAA University, School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
3Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
4Medicana Bahcelievler Hospital, Clinics of Orthopaedics and Traumatology, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.37313-21.4 AIM: To investigate the importance of thoracic kyphosis (TK) for treatment preference in patients with Lenke Type 5C adolescent idiopathic scoliosis by comparing radiological outcomes of the patients who underwent selective fusion (SF) or nonselective fusion (NSF).

MATERIAL and METHODS: Twenty-nine patients with Lenke Type 5C AIS were included and then divided into two groups as per the fusion procedure used in the surgical treatment. SF group including 16 patients (14 female patients; mean age = 15.56 yr; age range, 14?18) with normal TK and NSF group including 13 patients (nine female patients; mean age = 15.54 yr, age range, 13?18) with thoracic hyperkyphosis. Thoracolumbar/lumbar (TL/L) Cobb, thoracic (T) Cobb, TK and lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured on standing spine radiographs preoperatively and at the final follow-up. The correction rates (CRs) of Cobb angles and the difference in each other radiological parameters were calculated.

RESULTS: No significant differences were observed in the mean CRs of TL/L Cobb and T Cobb angles, PI, SS, and PT (p=0.313, p=0.444, p=0.51, p=0.472, and p=0.14, respectively). However, significant differences were observed in the mean TK angle, which was ?2.13° ± 13.52° (range, 29?27°) in SF group and 28.46° ± 15.05° (range, ?4°?°47°) in NSF group (p=0.001), and LL angle was 0.88° ± 14.23° (range, ?21°?32°) in SF group and 11.54° ± 17.79° (range, ?31°?34°) in NSF group (p = 0.016).

CONCLUSION: In patients in whom Lenke?s sagittal modifier is N, SF can be performed efficiently. NSF can be preferred for those with (+) Lenke?s sagittal modifiers as it provides better TK control. Keywords : Adolescent idiopathic scoliosis, Selective fusion, Nonselective fusion, Thoracic kyphosis, Type 5C

Corresponding author : Mehmet DEMIREL, dr88.mehmet.demirel@gmail.com