title: Selective thoracic fusion for adolescent idiopathic scoliosis with C modifier lumbar curves: 2- to 16-year radiographic and clinical results.
abstract: METHODS
  Retrospective clinical and radiographic review with functional outcome assessment.
  
  
  OBJECTIVE
  To evaluate outcome of selective thoracic fusion for adolescent idiopathic scoliosis in the presence of widely deviated compensatory lumbar curves.
  
  
  BACKGROUND
  Previous reports on the results of selective thoracic scoliosis fusion have not specifically focused on deformities with widely deviated lumbar curves. Whether these challenging deformities are best treated with selective thoracic fusion or fusion of both curves remains unclear.
  
  
  METHODS
  Forty-four consecutive patients with adolescent idiopathic scoliosis with main thoracic, compensatory minor lumbar "C" modifier curves underwent selective thoracic fusion at a single institution (1987-2000). Radiographs were analyzed before surgery, at 1 week, 2 years, and latest follow-up (2-16 years; mean 5.0 years).
  
  
  RESULTS
  A mean 36% thoracic correction was closely matched by a 34% lumbar correction at latest follow-up. A majority of spontaneous lumbar correction occurred at its cephalad segments (P = 0.001). Spontaneous correction of lumbar apical translation occurred in a majority of patients (prognostic factors identified). Global coronal imbalance (2-5 cm) was common before surgery and was a significant risk factor (P = 0.04) for global imbalance at latest follow-up. Postoperative bracing was not utilized, and there were no reoperations. Patients with coronal imbalance (2-5 cm) at latest follow-up had slightly inferior SRS-24 results.
  
  
  CONCLUSIONS
  Satisfactory results are achieved with selective thoracic fusion of properly selected C modifier lumbar curves. Correction of the lumbar curve results principally from a decrease in the tilt of its upper vertebrae, but not necessarily improved apical translation. Mild coronal imbalance was well tolerated and has not necessitated distal extension of the fusion.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Edwards
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Michael
authors.initials: M
authors.lastname: Peelle
authors.forename: Brenda
authors.initials: B
authors.lastname: Sides
authors.forename: Anthony
authors.initials: A
authors.lastname: Rinella
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D016025:Bone Transplantation; D001864:Bone Wires; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D018583:Pliability; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome