Well, if Lenke and all those other top surgeons don't know why their colleagues are not following the recommendation to only fusion the thorax in false doubles then I suggest the guys ignoring the recommendations may not know either. Can't they just ask around at the next meeting? Maybe even buttonhole some of them? Wow.
Selective Thoracic Fusion in Lenke 1C Curves: Prevalence and Criteria IMAST 2011 Paper #89
Crawford, Charles H. III MD; Lenke, Lawrence G. MD; Sucato, Daniel J. MD, MS; Richards, B. Stephens III MD; Emans, John B. MD; Vitale, Michael G. MD; Erickson, Mark A. MD; Sanders, James O. MD
Published Ahead-of-Print
Abstract
Study Design. Multicenter retrospective analysis of prospectively collected data.
Objective. Evaluate radiographic and clinical characteristics of patients undergoing an STF for Lenke 1C curves.
Summary of Background Data. Selective thoracic fusion (STF) of adolescent idiopathic scoliosis (AIS) has been advocated for the so-called "false double major" curve (Lenke 1C/King Type II). Despite these recommendations, many surgeons continue to perform non-selective fusions (NSF) for this curve type. It is unknown to what extent other factors influence the surgeon's fusion level selection.
Methods. A prospective multicenter database included 264 patients with surgically treated Lenke 1C curves and were divided into two groups. The STF group included patients with the lowest instrumented vertebra (LIV) at or cephalad to L1, while the NSF group included patients with the LIV at or caudal to L3. Preoperative radiographic, clinical (scoliometer), Scoliosis Appearance Questionnaire (SAQ), and Scoliosis Research Society (SRS) questionnaires were analyzed and compared.
Results. Only 138/264 patients (49%) underwent an STF. Gender ratio (90% vs. 86% female), average age (14.7 vs. 14.8 years), and preoperative main thoracic (MT) Cobb angles (56.0[degrees]+/-9.9 vs. 55.3[degrees]+/-11.4) were not significantly different (STF vs. NSF). However, the average thoracolumbar/lumbar (TL/L) preoperative Cobb angle was significantly smaller in the STF group (42.1[degrees]+/-8.6 vs. 47.0[degrees]+/-9.0; p<0.001) while the MT:TL/L Cobb ratio (1.35+/-0.20 vs. 1.18+/-0.15; p<0.001), apical vertebral translation and rotation (1.82+/-0.59 vs. 1.31+/-0.53; p<0.001), (1.16 vs. 0.98; p<0.001) were significantly greater in the STF group. Preoperative coronal balance, sagittal Cobb angles (including T10-L2 kyphosis) and Risser Grade were not significantly different. Preoperative TL/L scoliometer measures were significantly less in the STF group (8.1[degrees]+/-3.7 vs. 10.3[degrees]+/-5.4; p = 0.001). On the SAQ, the STF group had less desire for an appearance change.
Conclusion. Despite the recommendation to fuse only the structural thoracic curve in a 1C curve, only 49% of patients were treated with an STF. An STF resulted in smaller TL/L Cobb angles, less TL/L clinical deformity, larger MT:TL/L ratios, and less desire for an appearance change.
(C) 2013 Lippincott Williams & Wilkins, Inc.
Crawford, Charles H. III MD; Lenke, Lawrence G. MD; Sucato, Daniel J. MD, MS; Richards, B. Stephens III MD; Emans, John B. MD; Vitale, Michael G. MD; Erickson, Mark A. MD; Sanders, James O. MD
Published Ahead-of-Print
Abstract
Study Design. Multicenter retrospective analysis of prospectively collected data.
Objective. Evaluate radiographic and clinical characteristics of patients undergoing an STF for Lenke 1C curves.
Summary of Background Data. Selective thoracic fusion (STF) of adolescent idiopathic scoliosis (AIS) has been advocated for the so-called "false double major" curve (Lenke 1C/King Type II). Despite these recommendations, many surgeons continue to perform non-selective fusions (NSF) for this curve type. It is unknown to what extent other factors influence the surgeon's fusion level selection.
Methods. A prospective multicenter database included 264 patients with surgically treated Lenke 1C curves and were divided into two groups. The STF group included patients with the lowest instrumented vertebra (LIV) at or cephalad to L1, while the NSF group included patients with the LIV at or caudal to L3. Preoperative radiographic, clinical (scoliometer), Scoliosis Appearance Questionnaire (SAQ), and Scoliosis Research Society (SRS) questionnaires were analyzed and compared.
Results. Only 138/264 patients (49%) underwent an STF. Gender ratio (90% vs. 86% female), average age (14.7 vs. 14.8 years), and preoperative main thoracic (MT) Cobb angles (56.0[degrees]+/-9.9 vs. 55.3[degrees]+/-11.4) were not significantly different (STF vs. NSF). However, the average thoracolumbar/lumbar (TL/L) preoperative Cobb angle was significantly smaller in the STF group (42.1[degrees]+/-8.6 vs. 47.0[degrees]+/-9.0; p<0.001) while the MT:TL/L Cobb ratio (1.35+/-0.20 vs. 1.18+/-0.15; p<0.001), apical vertebral translation and rotation (1.82+/-0.59 vs. 1.31+/-0.53; p<0.001), (1.16 vs. 0.98; p<0.001) were significantly greater in the STF group. Preoperative coronal balance, sagittal Cobb angles (including T10-L2 kyphosis) and Risser Grade were not significantly different. Preoperative TL/L scoliometer measures were significantly less in the STF group (8.1[degrees]+/-3.7 vs. 10.3[degrees]+/-5.4; p = 0.001). On the SAQ, the STF group had less desire for an appearance change.
Conclusion. Despite the recommendation to fuse only the structural thoracic curve in a 1C curve, only 49% of patients were treated with an STF. An STF resulted in smaller TL/L Cobb angles, less TL/L clinical deformity, larger MT:TL/L ratios, and less desire for an appearance change.
(C) 2013 Lippincott Williams & Wilkins, Inc.
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