title: Adolescent idiopathic scoliosis treated with open instrumented anterior spinal fusion: five-year follow-up.
abstract: METHODS
  A multicenter prospective database was queried for patients who underwent open instrumented anterior spinal fusion (OASF) for treatment of primary thoracic (Lenke 1) adolescent idiopathic scoliosis (AIS).
  
  
  OBJECTIVE
  To present the intermediate radiographic and pulmonary function testing (PFT) data from patients who underwent OASF using modern, rigid instrumentation.
  
  
  BACKGROUND
  Anterior spinal fusion is an excellent method to correct the 3-dimensional deformity produced by AIS. Modern instrumentation consisting of stronger metals, unthreaded rods, and dual rod systems should theoretically decrease the incidence of rod breakage, pseudarthrosis, and loss of correction seen in earlier OASF studies. The paucity of intermediate and long-term data prevents surgeons and patients from making an informed decision regarding the true incidence of these complications.
  
  
  METHODS
  Of 101 potential patients who underwent OASF with a minimum 5-year follow-up, 85 (85%) were studied. Standing radiographs were analyzed before surgery and at first standing erect, 2-year, and 5-year follow-up. PFT data were collected before surgery and at 5 years after surgery.
  
  
  RESULTS
  Complete 5-year follow-up was obtained in 85 patients. Five years after surgery, the mean coronal correction was 26 degrees (51%; P < 0.05) and the thoracolumbar/lumbar curve improved 16 degrees (51%). There was a 9-degree (P < 0.001) increase in kyphosis, and there were 9 patients (11%) in whom the C7 plumb line translated >2 cm. There was a 6.7% decrease in predicted FEV1 over the 5-year period, from 75.5% +/- 13% before surgery to 68.8% +/- 2% at 5-year follow-up (P = 0.007); however, there was no significant change in FVC. There were 3 significant adverse events: 1 implant breakage requiring reoperation and 2 cases of progression of the main thoracic curve requiring reoperation.
  
  
  CONCLUSIONS
  OASF is a reproducible and safe method to treat thoracic AIS. It provides good coronal and sagittal correction of the main thoracic and compensatory thoracolumbar/lumbar curves that is maintained with intermediate term follow-up. In skeletally immature children, this technique can cause an increase in kyphosis beyond normal values, and less correction of kyphosis should be considered during instrumentation. As with any procedure that employs a thoracotomy, pulmonary function is mildly decreased at final follow-up.
authors.affiliation: Walter Reed Army Medical Center, WA, DC, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Tis
authors.forename: Michael F
authors.initials: MF
authors.lastname: O'Brien
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: David H
authors.initials: DH
authors.lastname: Clements
authors.forename: Jürgen
authors.initials: J
authors.lastname: Harms
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001858:Bone Nails / Q000009:adverse effects; D002648:Child; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome