Selective Spinal Fusion for Lenke Type 5C Adolescent Idiopathic Scoliosis: Short Term Radiographic Follow Up.
Keywords:
Adolescent Idiopathic Scoliosis, Cobb angle, Lenke type 5C, Pedicle, Spine.Abstract
Objective: To determine the short term radiological outcomes of Lenke type 5C adolescent idiopathic scoliosis in terms of Cobb angle correction and coronal balance after selective posterior segmental spinal instrumentation with pedicle screws.
Methods: This retrospective cohort study was conducted in Department of Orthopedic and Spine Surgery Ghurki Trust Teaching Hospital/ Lahore Medical and Dental College Lahore. The medical records of patients from 17th April 2015 to 29th October 2019 who underwent selective spinal fusion with pedicle screws for Lenke type 5C adolescent idiopathic scoliosis were reviewed. Pre-operative radiographs were evaluated for Cobb angle of lumbar or thoracolumbar curve as well as sagittal and lumbar modifier on anteroposterior and lateral standing films. The curve correction, implant density, number of segment fused and coronal balance was assessed on post operative radiographs. The pre and post operative comparison of important study variables were done and P value was calculated with the help of Chi-square test. P value < 0.05 was considered statistically significant.
Results: The total number of patients were 34. Majority (94.1%,n=32) were females while only 2(5.9%) were males. The mean age at the time of operation was 14.35±2.19 years (range 8 to 19 years). Mean pre-operative and post-operative Cobb angles were 61.790±13.120 (range 400 to 850) and 10.550±8.710 (range 00 to 300) respectively (P value 0.00). The mean percentage of curve correction and percentage of fulcrum flexibility was 83.35±13.07 % (range 55% to 100%) and 59.56%±15.07 (range 28.57% to 84.60%) respectively (P value 0.469). Mean implant density and fusion mass was 66.03±7.94% (range 53 to 79%) and 10.32±2.8 (range 7 to 15%) segments respectively. The coronal balance was achieved in all patients. No major complication was noted.
Conclusion: Near normal Cobb angle correction and coronal balance was achieved in all patients of Lenke type 5C adolescent idiopathic scoliosis treated with posterior segmental spinal instrumentation utilizing pedicle screws.
References
Slattery C, Verma K. Classifications in Brief: The Lenke Classification for Adolescent Idiopathic Scoliosis. Clinic Orthop Rel Res. 2018;476(11):227-231.
Li Z, Li G, Chen C, Li Y, Yang C, Li M, et al. The radiographic parameter risk factors of rapid curve progression in Lenke 5 and 6 adolescent idiopathic scoliosis: A retrospective study. Medicine. 2017;96(52).113-118.
Zhang H, Hu X, Wang Y, Yin X, Tang M, Guo C, et al. Use of finite element analysis of a Lenke type 5 adolescent idiopathic scoliosis case to assess possible surgical outcomes. Computer Aided Surgery. 2013;18(3-4):84-92.
Ilharreborde B, Ferrero E, Angelliaume A, Lefevre Y, Accadbled F, Simon AL, et al. Selective versus hyperselective posterior fusions in Lenke 5 adolescent idiopathic scoliosis: Comparison of radiological and clinical outcomes. European Spine Journal. 2017;26(6):1739-47.
Samartzis D, Leung Y, Shigematsu H, Natarajan D, Stokes O, Mak KC, et al. Selection of fusion levels using the fulcrum bending radiograph for the management of adolescent idiopathic scoliosis in patients with alternate level pedicle screw strategy: Clinical decision-making and outcomes. PLoS One. 2015;10(8):345-351.
Siderakis N, Rosado JP, Ariel Aguilar A, Dinelli D, Lutzky L , Reviriego J, et al.Analysis of coronal balance and last level of arthrodesis in Lenke type 5 Idiopathic scoliosis:Specific radiographic parameters. Coluna/Columna. 2013; 12(4):296-9
Nadeem U, Shah A, Zaman AuZ, Aziz A. Selection of Lowest Instrumented Vertebra in the Management of Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis using Pedicle Screw Instrumentation. Global Spine Journal. 2016;6:553-560.
Zhang Y, Lin G, Zhang J, Guo J, Wang S, Yang Y, et al. Radiographic evaluation of posterior selective thoracolumbar or lumbar fusion for moderate Lenke 5C curves. Archives of orthopaedic and trauma surgery. 2017;137(1):1-8.
Sun X, Qiu Y, Liu Z, Ma WW, Wang B, Zhu ZZ, et al. Interbody cage support improves reconstruction of sagittal balance after anterior selective fusion in Lenke type 5 idiopathic scoliosis patients. Orthopaedic Surgery. 2009;1(4):285-92.
Liu Z, Guo J, Zhu Z, Qian B, Sun X, Xu L, et al. Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion. European Spine Journal. 2013;22(11):2392-8.
Luo M, Wang W, Shen M, Xia L. Anterior versus posterior approach in Lenke 5C adolescent idiopathic scoliosis: A meta-analysis of fusion segments and radiological outcomes. Journal of Orthopaedic Surgery and Research. 2016;11(1):77-82.
Cheung KM, Natarajan D, Samartzis D, Wong YW, Cheung WY, Luk KD. Predictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixation. J Bone Joint Surg. 2010;92(1):169-76.
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD Pocock SJ, Poole C, et al.) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med.2007;4(10):297-312.
Li J, Hwang SW, Shi Z, Yan N, Yang C, Wang C, et al. Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5C patients. Spine. 2011;36(20):1673-8.
Wang F, Xu XM, Lu Y, Wei XZ, Zhu XD, Li M. Comparative analysis of interval, skipped, and key-vertebral pedicle screw strategies for correction in patients with Lenke type 1 adolescent idiopathic scoliosis. Medicine. 2016;95(10).21-26.
Shetty AP, Suresh S, Aiyer SN, Kanna R, Rajasekaran S. Radiological factors affecting post-operative global coronal balance in Lenke 5 C scoliosis. Journal of Spine Surgery. 2017;3(4):541-547.
O'Donnell C, Michael N, Pan X, Emans J, Garg S, Erickson M. Anterior spinal fusion and posterior spinal fusion both effectively treat Lenke type 5 curves in adolescent idiopathic scoliosis: A multicenter study. Spine deformity. 2018;6(3):231-40.
Liu Z, Hu Zs, Qiu Y, Zhang Z, Zhao Zh, Han X, et al. Role of clavicle chest cage angle difference in predicting postoperative shoulder balance in Lenke 5C adolescent idiopathic scoliosis patients after selective posterior fusion. Orthopaedic surgery. 2017;9(1):86-90.
Chen J, Yang C, Ran B, Wang Y, Wang C, Zhu X, et al. Correction of Lenke 5 adolescent idiopathic scoliosis using pedicle screw instrumentation: does implant density influence the correction? Spine. 2013;38(15):946-51.
Sariyilmaz K, Ozkunt O, Karademir G, Gemalmaz HC, Dikici F, Domanic U. Does pedicle screw density matter in Lenke type 5 adolescent idiopathic scoliosis? Medicine. 2018;97(2).233-240.
Tannous OO, Banagan KE, Belin EJ, Jazini E, Weir TB, Ludwig SC, et al. Low-density pedicle screw constructs for adolescent idiopathic scoliosis: evaluation of effectiveness and cost. Global spine journal. 2018;8(2):114-20.