Predicting the outcome of selective thoracic fusion in false double major lumbar C cases with five-to twenty-four-year follow-up

Michael S. Chang, Keith H. Bridwell, Lawrence G. Lenke, Woojin Cho, Christine Baldus, Joshua D. Auerbach, Charles H. Crawford, Brian A. O'Shaughnessy

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Study Design. Retrospective radiographic and clinical study. Objective. To examine the long-term outcome of selective thoracic fusion (STF) performed for lumbar "C" modifier curves in adolescent idiopathic scoliosis. Summary Of Background Data. The efficacy of STF in lumbar "C" false double major curves is controversial. We examined the 5-to 24-year outcomes of patients with "C" lumbar curves who underwent STF at a single institution to determine which factors help predict successful outcome. Methods. Thirty-two patients (age, 14.8 ± 2.0 years) with a lumbar "C" modifier underwent primary STF and had minimum 5-year follow-up (mean, 6.8 years). All patients were fused distally to either T12 or L1. At latest follow-up, 18 were considered successful (group S), 2 required reoperation to accommodate worsening deformity (group R), and 12 were considered marginal outcomes (group M), as defined by >3 cm coronal imbalance (n = 5), >5 mm worsening of lumbar apical vertebra translation compared with preoperative (n = 4), >1 Nash-Moe grade worsening of lumbar apical vertebra rotation (n = 1), >10° thoracolumbar junction kyphosis which was at least 5° worse than preoperative (n = 5), and lumbar Cobb angle >5° worse than preoperative (n = 2). Clinical outcomes were determined by Scoliosis Research Society (SRS)-30 at final follow-up. RESULTS.: Of the multiple factors considered, 2-month postoperative standing lumbar sagittal alignment was most predictive for long-term outcome (P < 0.019 by Kruskal-Wallis ANOVA). Satisfactory outcomes had statistically significantly greater T12-S1 lordosis than those that were marginal (64.8° (group S) vs. 52.0° ° (group M); P = 0.014) or required reoperation (64.8° [group S] vs. 38.0° [group R]; P < 0.001). Traditionally considered variables such as apical vertebra rotation, apical vertebra translation, Cobb angle magnitudes, coronal and sagittal balance, and their respective thoracic-to-lumbar ratios were not independently significant. Conclusion. Selective thoracic fusions performed for lumbar "C" modifier scoliotic deformities generally have excellent long-term radiographic and SRS-30 outcomes at 5-to 24-year follow-up. Care should be taken to ensure that overcorrection of the thoracic curve is not performed beyond the ability of the lumbar curve to compensate. Furthermore, consideration of selective thoracic fusion should not be ruled out simply because the patient may have a somewhat stiff lumbar curve based on side-bending radiographs.

Original languageEnglish (US)
Pages (from-to)2128-2133
Number of pages6
JournalSpine
Volume35
Issue number24
DOIs
StatePublished - Nov 15 2010
Externally publishedYes

Fingerprint

Thorax
Scoliosis
Lumbar Vertebrae
Reoperation
Spine
Lordosis
Kyphosis
Research
Analysis of Variance
Retrospective Studies

Keywords

  • adolescent idiopathic scoliosis
  • complications
  • long-term outcome
  • selective thoracic fusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Chang, M. S., Bridwell, K. H., Lenke, L. G., Cho, W., Baldus, C., Auerbach, J. D., ... O'Shaughnessy, B. A. (2010). Predicting the outcome of selective thoracic fusion in false double major lumbar C cases with five-to twenty-four-year follow-up. Spine, 35(24), 2128-2133. https://doi.org/10.1097/BRS.0b013e3181e5e36e

Predicting the outcome of selective thoracic fusion in false double major lumbar C cases with five-to twenty-four-year follow-up. / Chang, Michael S.; Bridwell, Keith H.; Lenke, Lawrence G.; Cho, Woojin; Baldus, Christine; Auerbach, Joshua D.; Crawford, Charles H.; O'Shaughnessy, Brian A.

In: Spine, Vol. 35, No. 24, 15.11.2010, p. 2128-2133.

Research output: Contribution to journalArticle

Chang, MS, Bridwell, KH, Lenke, LG, Cho, W, Baldus, C, Auerbach, JD, Crawford, CH & O'Shaughnessy, BA 2010, 'Predicting the outcome of selective thoracic fusion in false double major lumbar C cases with five-to twenty-four-year follow-up', Spine, vol. 35, no. 24, pp. 2128-2133. https://doi.org/10.1097/BRS.0b013e3181e5e36e
Chang, Michael S. ; Bridwell, Keith H. ; Lenke, Lawrence G. ; Cho, Woojin ; Baldus, Christine ; Auerbach, Joshua D. ; Crawford, Charles H. ; O'Shaughnessy, Brian A. / Predicting the outcome of selective thoracic fusion in false double major lumbar C cases with five-to twenty-four-year follow-up. In: Spine. 2010 ; Vol. 35, No. 24. pp. 2128-2133.
@article{cf3968ebacfa46339a56abdca0222953,
title = "Predicting the outcome of selective thoracic fusion in false double major lumbar C cases with five-to twenty-four-year follow-up",
abstract = "Study Design. Retrospective radiographic and clinical study. Objective. To examine the long-term outcome of selective thoracic fusion (STF) performed for lumbar {"}C{"} modifier curves in adolescent idiopathic scoliosis. Summary Of Background Data. The efficacy of STF in lumbar {"}C{"} false double major curves is controversial. We examined the 5-to 24-year outcomes of patients with {"}C{"} lumbar curves who underwent STF at a single institution to determine which factors help predict successful outcome. Methods. Thirty-two patients (age, 14.8 ± 2.0 years) with a lumbar {"}C{"} modifier underwent primary STF and had minimum 5-year follow-up (mean, 6.8 years). All patients were fused distally to either T12 or L1. At latest follow-up, 18 were considered successful (group S), 2 required reoperation to accommodate worsening deformity (group R), and 12 were considered marginal outcomes (group M), as defined by >3 cm coronal imbalance (n = 5), >5 mm worsening of lumbar apical vertebra translation compared with preoperative (n = 4), >1 Nash-Moe grade worsening of lumbar apical vertebra rotation (n = 1), >10° thoracolumbar junction kyphosis which was at least 5° worse than preoperative (n = 5), and lumbar Cobb angle >5° worse than preoperative (n = 2). Clinical outcomes were determined by Scoliosis Research Society (SRS)-30 at final follow-up. RESULTS.: Of the multiple factors considered, 2-month postoperative standing lumbar sagittal alignment was most predictive for long-term outcome (P < 0.019 by Kruskal-Wallis ANOVA). Satisfactory outcomes had statistically significantly greater T12-S1 lordosis than those that were marginal (64.8° (group S) vs. 52.0° ° (group M); P = 0.014) or required reoperation (64.8° [group S] vs. 38.0° [group R]; P < 0.001). Traditionally considered variables such as apical vertebra rotation, apical vertebra translation, Cobb angle magnitudes, coronal and sagittal balance, and their respective thoracic-to-lumbar ratios were not independently significant. Conclusion. Selective thoracic fusions performed for lumbar {"}C{"} modifier scoliotic deformities generally have excellent long-term radiographic and SRS-30 outcomes at 5-to 24-year follow-up. Care should be taken to ensure that overcorrection of the thoracic curve is not performed beyond the ability of the lumbar curve to compensate. Furthermore, consideration of selective thoracic fusion should not be ruled out simply because the patient may have a somewhat stiff lumbar curve based on side-bending radiographs.",
keywords = "adolescent idiopathic scoliosis, complications, long-term outcome, selective thoracic fusion",
author = "Chang, {Michael S.} and Bridwell, {Keith H.} and Lenke, {Lawrence G.} and Woojin Cho and Christine Baldus and Auerbach, {Joshua D.} and Crawford, {Charles H.} and O'Shaughnessy, {Brian A.}",
year = "2010",
month = "11",
day = "15",
doi = "10.1097/BRS.0b013e3181e5e36e",
language = "English (US)",
volume = "35",
pages = "2128--2133",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "24",

}

TY - JOUR

T1 - Predicting the outcome of selective thoracic fusion in false double major lumbar C cases with five-to twenty-four-year follow-up

AU - Chang, Michael S.

AU - Bridwell, Keith H.

AU - Lenke, Lawrence G.

AU - Cho, Woojin

AU - Baldus, Christine

AU - Auerbach, Joshua D.

AU - Crawford, Charles H.

AU - O'Shaughnessy, Brian A.

PY - 2010/11/15

Y1 - 2010/11/15

N2 - Study Design. Retrospective radiographic and clinical study. Objective. To examine the long-term outcome of selective thoracic fusion (STF) performed for lumbar "C" modifier curves in adolescent idiopathic scoliosis. Summary Of Background Data. The efficacy of STF in lumbar "C" false double major curves is controversial. We examined the 5-to 24-year outcomes of patients with "C" lumbar curves who underwent STF at a single institution to determine which factors help predict successful outcome. Methods. Thirty-two patients (age, 14.8 ± 2.0 years) with a lumbar "C" modifier underwent primary STF and had minimum 5-year follow-up (mean, 6.8 years). All patients were fused distally to either T12 or L1. At latest follow-up, 18 were considered successful (group S), 2 required reoperation to accommodate worsening deformity (group R), and 12 were considered marginal outcomes (group M), as defined by >3 cm coronal imbalance (n = 5), >5 mm worsening of lumbar apical vertebra translation compared with preoperative (n = 4), >1 Nash-Moe grade worsening of lumbar apical vertebra rotation (n = 1), >10° thoracolumbar junction kyphosis which was at least 5° worse than preoperative (n = 5), and lumbar Cobb angle >5° worse than preoperative (n = 2). Clinical outcomes were determined by Scoliosis Research Society (SRS)-30 at final follow-up. RESULTS.: Of the multiple factors considered, 2-month postoperative standing lumbar sagittal alignment was most predictive for long-term outcome (P < 0.019 by Kruskal-Wallis ANOVA). Satisfactory outcomes had statistically significantly greater T12-S1 lordosis than those that were marginal (64.8° (group S) vs. 52.0° ° (group M); P = 0.014) or required reoperation (64.8° [group S] vs. 38.0° [group R]; P < 0.001). Traditionally considered variables such as apical vertebra rotation, apical vertebra translation, Cobb angle magnitudes, coronal and sagittal balance, and their respective thoracic-to-lumbar ratios were not independently significant. Conclusion. Selective thoracic fusions performed for lumbar "C" modifier scoliotic deformities generally have excellent long-term radiographic and SRS-30 outcomes at 5-to 24-year follow-up. Care should be taken to ensure that overcorrection of the thoracic curve is not performed beyond the ability of the lumbar curve to compensate. Furthermore, consideration of selective thoracic fusion should not be ruled out simply because the patient may have a somewhat stiff lumbar curve based on side-bending radiographs.

AB - Study Design. Retrospective radiographic and clinical study. Objective. To examine the long-term outcome of selective thoracic fusion (STF) performed for lumbar "C" modifier curves in adolescent idiopathic scoliosis. Summary Of Background Data. The efficacy of STF in lumbar "C" false double major curves is controversial. We examined the 5-to 24-year outcomes of patients with "C" lumbar curves who underwent STF at a single institution to determine which factors help predict successful outcome. Methods. Thirty-two patients (age, 14.8 ± 2.0 years) with a lumbar "C" modifier underwent primary STF and had minimum 5-year follow-up (mean, 6.8 years). All patients were fused distally to either T12 or L1. At latest follow-up, 18 were considered successful (group S), 2 required reoperation to accommodate worsening deformity (group R), and 12 were considered marginal outcomes (group M), as defined by >3 cm coronal imbalance (n = 5), >5 mm worsening of lumbar apical vertebra translation compared with preoperative (n = 4), >1 Nash-Moe grade worsening of lumbar apical vertebra rotation (n = 1), >10° thoracolumbar junction kyphosis which was at least 5° worse than preoperative (n = 5), and lumbar Cobb angle >5° worse than preoperative (n = 2). Clinical outcomes were determined by Scoliosis Research Society (SRS)-30 at final follow-up. RESULTS.: Of the multiple factors considered, 2-month postoperative standing lumbar sagittal alignment was most predictive for long-term outcome (P < 0.019 by Kruskal-Wallis ANOVA). Satisfactory outcomes had statistically significantly greater T12-S1 lordosis than those that were marginal (64.8° (group S) vs. 52.0° ° (group M); P = 0.014) or required reoperation (64.8° [group S] vs. 38.0° [group R]; P < 0.001). Traditionally considered variables such as apical vertebra rotation, apical vertebra translation, Cobb angle magnitudes, coronal and sagittal balance, and their respective thoracic-to-lumbar ratios were not independently significant. Conclusion. Selective thoracic fusions performed for lumbar "C" modifier scoliotic deformities generally have excellent long-term radiographic and SRS-30 outcomes at 5-to 24-year follow-up. Care should be taken to ensure that overcorrection of the thoracic curve is not performed beyond the ability of the lumbar curve to compensate. Furthermore, consideration of selective thoracic fusion should not be ruled out simply because the patient may have a somewhat stiff lumbar curve based on side-bending radiographs.

KW - adolescent idiopathic scoliosis

KW - complications

KW - long-term outcome

KW - selective thoracic fusion

UR - http://www.scopus.com/inward/record.url?scp=78649446166&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649446166&partnerID=8YFLogxK

U2 - 10.1097/BRS.0b013e3181e5e36e

DO - 10.1097/BRS.0b013e3181e5e36e

M3 - Article

VL - 35

SP - 2128

EP - 2133

JO - Spine

JF - Spine

SN - 0362-2436

IS - 24

ER -