title: Radiographic evaluation of posterior selective thoracolumbar or lumbar fusion for moderate Lenke 5C curves.
abstract: BACKGROUND
  Posterior selective thoracolumbar or lumbar (TL/L) fusion with pedicle screw constructs for adolescent idiopathic scoliosis (AIS) has been studied in a few researches. However, few studies have discussed the indication for selective TL/L fusion and the behaviors of its adjacent disc angle. The present study aims to discuss the indication for posterior selective TL/L fusion and the behavior of the adjacent disc angle.
  
  
  METHODS
  45 consecutive cases of AIS undergoing posterior selective TL/L fusion were retrospectively evaluated, with an average follow-up of 36 months. Radiographs were reviewed to determine the coronal curve magnitude and the sagittal alignment preoperatively, postoperatively and at final follow-up. Thoracic curves in groups A had a correction loss of more than 5°, while thoracic curves in group B had a correction loss of not more than 5°.
  
  
  RESULTS
  The coronal curve magnitude of the TL/L curve averaged 44° preoperatively and it was corrected to 6° immediately with a correction rate of 84.8 %. At final follow-up it was 9° with a correction loss of 3°. The minor thoracic curve was 26° preoperatively, and the convex side bending curve magnitude averaged 8° with a flexibility of 72.7 %. It was corrected to 13° immediately with a spontaneous correction of 48.5 %. At final follow-up it was 14° with a correction loss of 1°. UIVA decreased from 4° to 2° after surgery, and it was 2° at final follow-up. LIVA decreased from 7° to 4° after surgery, and it was 5° at final follow-up. Maximal correction of TL/L curves in group A is significantly less than that in group B. 1 patient received revision surgery to fuse the progressive thoracic curve.
  
  
  CONCLUSIONS
  Posterior selective TL/L fusion with pedicle screw constructs allows for spontaneous thoracic correction and maintains coronal and sagittal balance during the follow-up. Maximal correction instead of undercorrection was recommended for moderate Lenke 5C curves. Disc wedging could be improved after surgery and well maintained during the follow-up.
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
authors.forename: Yanbin
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
authors.forename: Guanfeng
authors.initials: G
authors.lastname: Lin
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China. jgzhang_pumch@yahoo.com.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
authors.forename: Shengru
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
authors.forename: Jianxiong
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
authors.forename: Yipeng
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D065289:Pedicle Screws; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Disc wedging; Indication; Maximal correction; Selective fusion; Thoracolumbar or lumbar