title: Anterior lumbar instrumentation improves correction of severe lumbar Lenke C curves in double major idiopathic scoliosis.
abstract: Fifteen skeletally immature patients with double major adolescent idiopathic scoliosis with large lumbar curves and notable L4 and L5 coronal plane obliquity were retrospectively studied. Seven patients who underwent anterior release and fusion of the lumbar curve with segmental anterior instrumentation and subsequent posterior instrumentation ending at L3 were compared with eight patients treated with anterior release and fusion without anterior instrumentation followed by posterior instrumentation to L3 or L4. At 4.5 years follow-up (range 2.5-7 years), curve correction, coronal balance and fusion rate were not statistically different between the two groups; however, the group with anterior instrumentation had improved coronal plane, near normalangulation in the distal unfused segment compared with the group without anterior instrumentation. In cases involving severe lumbar curvatures in the context of double major scoliosis, when as a first stage anterior release is chosen, the addition of instrumentation appears to restore normal coronal alignment of the distal unfused lumbar segment, and may in certain cases save a level compared with traditional fusions to L4.
authors.affiliation: Department of Orthopaedic Surgery, Spine Service, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 3800, Boston, MA 02114, USA.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Yeon
authors.forename: Jacob
authors.initials: J
authors.lastname: Weinberg
authors.forename: Vincent
authors.initials: V
authors.lastname: Arlet
authors.forename: Jean A
authors.initials: JA
authors.lastname: Ouelett
authors.forename: Kirkham B
authors.initials: KB
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome