title: Surgical treatment of Lenke 1 main thoracic idiopathic scoliosis: results of a prospective, multicenter study.
abstract: METHODS
  Prospective, consecutive, nonrandomized, multicenter study.
  
  
  OBJECTIVE
  The purpose of this study was to compare the outcomes of idiopathic scoliosis treatment for Lenke 1 curves with 3 treatment approaches.
  
  
  BACKGROUND
  Surgical treatment options for Lenke 1 or primary main thoracic curve pattern in adolescent idiopathic scoliosis include thoracoscopic anterior spinal fusion, open anterior spinal fusion, and posterior spinal fusion (PSF) and instrumentation procedures.
  
  
  METHODS
  This was a prospective, consecutive, nonrandomized, multicenter study of surgical correction in adolescent idiopathic scoliosis. Patients with Lenke type 1 curve patterns from 7 sites were enrolled in this minimum 2-year follow-up study. Changes in pre- to postoperative radiographs, pulmonary function tests, Scoliosis Research Society questionnaire scores, and trunk rotation measures were compared.
  
  
  RESULTS
  A total of 149 patients (age: 14.5 ± 2 yr) were included (91% follow-up at 2 yr). The 3 groups were similar preoperatively in thoracic and lumbar curve size. There were 55 patients with thoracoscopic anterior spinal fusion, 17 patients with open anterior spinal fusion, and 64 patients with PSF. The fusion included on average 3 to 4 more levels in PSF than the 2 anterior approaches (P ≤ 0.001). Surgical time tended to be greater in the anterior groups by approximately 2 to 3 hours; however, blood loss was greatest with PSF. At 2 years, all 3 approaches showed similar improvements in the thoracic Cobb angle, coronal balance, the lumbar Cobb angle, Scoliosis Research Society questionnaire scores, and trunk rotation measures. The PSF approach resulted in overall reduction in kyphosis compared with the anterior approaches. Postoperative hyperkyphosis was an issue only in the 2 anterior groups. Major complication rates were similar.
  
  
  CONCLUSIONS
  All 3 approaches resulted in similarly satisfactory outcomes for the majority of patients with specific advantages to each technique. The patients with PSF had more levels fused, yet with the shortest operative time. The thoracoscopic anterior spinal fusion group had the smallest incisions and the lowest requirement for transfusion. The open anterior spinal fusion group had a modest loss of pulmonary function without any clear advantages compared with the other 2 groups.
  
  
  METHODS
  2.
authors.affiliation: Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, CA, USA. pnewton@rchsd.org
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Marks
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Bastrom
authors.forename: Randal
authors.initials: R
authors.lastname: Betz
authors.forename: David
authors.initials: D
authors.lastname: Clements
authors.forename: Baron
authors.initials: B
authors.lastname: Lonner
authors.forename: Alvin
authors.initials: A
authors.lastname: Crawford
authors.forename: Harry
authors.initials: H
authors.lastname: Shufflebarger
authors.forename: Michael
authors.initials: M
authors.lastname: OʼBrien
authors.forename: Burt
authors.initials: B
authors.lastname: Yaszay
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery; D008168:Lung / Q000503:physiopathology; D008297:Male; D010808:Physical Examination; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D012129:Respiratory Function Tests; D012600:Scoliosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States