title: Results of selective thoracic versus nonselective fusion in Lenke type 3 curves.
abstract: METHODS
  A retrospective analysis of a prospectively collected multicenter database.
  
  
  OBJECTIVE
  To identify the radiographical and clinical outcomes in Lenke 3 curves fused selectively (S) versus nonselectively (NS).
  
  
  BACKGROUND
  Surgical treatment options for Lenke 3 curves include fusion of both curves (NS) or selective thoracic curve fusion (S). Selective fusion of the thoracic curve spares lumbar motion segments; however, it may result in marked residual deformity.
  
  
  METHODS
  A prospectively collected multicenter database was retrospectively reviewed for adolescent idiopathic scoliosis Lenke 3 curves treated with posterior spinal fusion with a minimum of 2 years of follow-up. Patients were divided into 2 groups: NS (nonselective fusion) and S (selective thoracic fusion). Radiographical and clinical data were compared between the groups using the unpaired Student t test and analysis of variance.
  
  
  RESULTS
  A total of 74 patients met our inclusion criteria, with 49 (66.2%) in the NS group and 25 (33.8%) in the S group. Overall, both groups were similar preoperatively except for lumbar Cobb (NS = 56.3°, S = 47.2°, P < 0.001), lumbar lordosis (NS = 56.9°, S = 67.2°, P = 0.001), lumbar rotational prominence (NS = 11.2°, S = 8.2°, P < 0.05), and lumbar apical translation (NS = 3.2 cm, S = 1.9 cm, P < 0.05). Postoperatively, NS fusion demonstrated significantly less coronal imbalance of 2 cm or less (NS = 10.2%, S = 56.0%, P < 0.001), better lumbar curve correction (NS = 68.2%, S = 51.9%, P < 0.001), better lumbar apical translation correction (NS = 1.2 cm, S = 2.1 cm, P < 0.01), and better percent correction of the lumbar prominence (NS = 66.5%, S = 40.4%, P < 0.05). Scoliosis Research Society Questionnaire 22 scores at 2 years were similar between the groups.
  
  
  CONCLUSIONS
  Despite preoperatively smaller lumbar curves with less apical translation and lumbar prominence, most patients with selective fusions were out of balance postoperatively and had inferior radiographical outcomes as compared with their nonselective comparison cohort with similar patient-reported outcomes. Long-term follow-up is required to determine whether the trade-off of sparing motion segments at the expense of somewhat lessened radiographical outcomes is worthwhile.
authors.affiliation: *University of Virginia Health System, Charlottesville, VA †Shriners Hospitals for Children, Philadelphia, PA ‡Johns Hopkins Hospital, Baltimore, MD §Rady Children's Hospital, San Diego, CA ¶NYU Hospital for Joint Diseases, New York, NY ‖British Columbia Children's Hospital, Vancouver, British Columbia, Canada; and **Institute for Spine & Scoliosis, Lawrenceville, NJ.
authors.forename: Anuj
authors.initials: A
authors.lastname: Singla
authors.forename: James T
authors.initials: JT
authors.lastname: Bennett
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Pahys
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Marks
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
authors.forename: Firoz
authors.initials: F
authors.lastname: Miyanji
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Cahill
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome