Singla Anuj, Bennett James T, Sponseller Paul D, Pahys Joshua M, Marks Michelle C, Lonner Baron S, Newton Peter O, Miyanji Firoz, Betz Randal R, Cahill Patrick J, Samdani Amer F
*University of Virginia Health System, Charlottesville, VA †Shriners Hospitals for Children, Philadelphia, PA ‡Johns Hopkins Hospital, Baltimore, MD §Rady Children's Hospital, San Diego, CA ¶NYU Hospital for Joint Diseases, New York, NY ‖British Columbia Children's Hospital, Vancouver, British Columbia, Canada; and **Institute for Spine & Scoliosis, Lawrenceville, NJ.
Spine (Phila Pa 1976). 2014 Nov 15;39(24):2034-41. doi: 10.1097/BRS.0000000000000623.
A retrospective analysis of a prospectively collected multicenter database.
To identify the radiographical and clinical outcomes in Lenke 3 curves fused selectively (S) versus nonselectively (NS).
Surgical treatment options for Lenke 3 curves include fusion of both curves (NS) or selective thoracic curve fusion (S). Selective fusion of the thoracic curve spares lumbar motion segments; however, it may result in marked residual deformity.
A prospectively collected multicenter database was retrospectively reviewed for adolescent idiopathic scoliosis Lenke 3 curves treated with posterior spinal fusion with a minimum of 2 years of follow-up. Patients were divided into 2 groups: NS (nonselective fusion) and S (selective thoracic fusion). Radiographical and clinical data were compared between the groups using the unpaired Student t test and analysis of variance.
A total of 74 patients met our inclusion criteria, with 49 (66.2%) in the NS group and 25 (33.8%) in the S group. Overall, both groups were similar preoperatively except for lumbar Cobb (NS = 56.3°, S = 47.2°, P < 0.001), lumbar lordosis (NS = 56.9°, S = 67.2°, P = 0.001), lumbar rotational prominence (NS = 11.2°, S = 8.2°, P < 0.05), and lumbar apical translation (NS = 3.2 cm, S = 1.9 cm, P < 0.05). Postoperatively, NS fusion demonstrated significantly less coronal imbalance of 2 cm or less (NS = 10.2%, S = 56.0%, P < 0.001), better lumbar curve correction (NS = 68.2%, S = 51.9%, P < 0.001), better lumbar apical translation correction (NS = 1.2 cm, S = 2.1 cm, P < 0.01), and better percent correction of the lumbar prominence (NS = 66.5%, S = 40.4%, P < 0.05). Scoliosis Research Society Questionnaire 22 scores at 2 years were similar between the groups.
Despite preoperatively smaller lumbar curves with less apical translation and lumbar prominence, most patients with selective fusions were out of balance postoperatively and had inferior radiographical outcomes as compared with their nonselective comparison cohort with similar patient-reported outcomes. Long-term follow-up is required to determine whether the trade-off of sparing motion segments at the expense of somewhat lessened radiographical outcomes is worthwhile.
对前瞻性收集的多中心数据库进行回顾性分析。
确定Lenke 3型脊柱侧弯选择性融合（S）与非选择性融合（NS）的影像学和临床结果。
Lenke 3型脊柱侧弯的手术治疗选择包括融合两条曲线（NS）或选择性胸椎曲线融合（S）。胸椎曲线的选择性融合保留了腰椎运动节段；然而，这可能会导致明显的残留畸形。
对前瞻性收集的多中心数据库进行回顾性研究，纳入接受后路脊柱融合术治疗的青少年特发性脊柱侧弯Lenke 3型患者，随访至少2年。患者分为两组：NS（非选择性融合）组和S（选择性胸椎融合）组。使用非配对学生t检验和方差分析比较两组的影像学和临床数据。
共有74例患者符合纳入标准，NS组49例（66.2%），S组25例（33.8%）。总体而言，两组术前情况相似，但腰椎Cobb角（NS = 56.3°，S = 47.2°，P < 0.001）、腰椎前凸（NS = 56.9°，S = 67.2°，P = 0.001）、腰椎旋转突出（NS = 11.2°，S = 8.2°，P < 0.05）和腰椎顶椎平移（NS = 3.2 cm，S = 1.9 cm，P < 0.
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