title: Anterior Dual Rod Versus Posterior Pedicle Fixation Surgery for the Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis: A Multicenter, Matched Case Analysis of 42 Patients.
abstract: METHODS
  Multicenter matched case analysis.
  
  
  OBJECTIVE
  Compare patients with Lenke 5C scoliosis surgically treated with anterior spinal fusion with dual rod instrumentation and anterior column support versus posterior release and pedicle screw instrumentation.
  
  
  BACKGROUND
  Treatment of single, structural, lumbar and thoracolumbar curves in patients with adolescent idiopathic scoliosis (AIS) has been the subject of some debate. Previous papers directly comparing these approaches are problematic because of heterogeneity of the groups, nonrandomized protocols, and surgeon bias and variation of instrumentation (upper instrumented vertebrae and lower instrumented vertebrae) in relation to the defined Cobb angle (upper end vertebra and lower end vertebrae). This report sought to remedy these flaws by analyzing a database of Lenke 5C AIS and performing matched cases.
  
  
  METHODS
  We analyzed 96 patients with Lenke 5C AIS curves based on radiographic and clinical data at 3 institutions, surgically treated between 2001 and 2005 with minimum 2-year follow-up. Case matched criteria (age within 1 year, sex, curve within 5°, lower end vertebrae, and lower instrumented vertebrae) yielded 21 matched patient pairs. We evaluated and compared multiple clinical and radiographic parameters.
  
  
  RESULTS
  We observed no significant statistical differences between groups in any preoperative clinical or radiographic parameters. At final follow-up, the major curve measured 8° (83%) in the posterior spinal fusion group, compared with 13° (72%) in the anterior spinal fusion group (p = .002). Estimated blood loss was similar in both groups. Hospital stay was significantly shorter in the posterior spinal fusion group. There were no differences in radiographic complications, such as proximal junctional kyphosis.
  
  
  CONCLUSIONS
  At a minimum of 2 years' follow-up in a multicenter, matched case analysis, adolescents with Lenke 5C curves demonstrated statistically significantly better curve correction and shorter hospital stays when treated with a posterior release with pedicle screw instrumented fusion compared with an anterior instrumented fusion with dual rods for similar patient populations.
authors.affiliation: Seton Spine and Scoliosis Center, 1600 West 38th Street, Suite 200, Austin, TX 78731, USA. Electronic address: Mattgeck@mac.com.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Geck
authors.affiliation: Illinois Spine and Scoliosis Center, 12701 W 143rd St, #110, Homer Glen, IL 60491, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rinella
authors.affiliation: Seton Spine and Scoliosis Center, 1600 West 38th Street, Suite 200, Austin, TX 78731, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Hawthorne
authors.affiliation: Miami Children's Hospital, 3601 NW 107th Ave, Miami, FL 33178, USA.
authors.forename: Angel
authors.initials: A
authors.lastname: Macagno
authors.affiliation: Washington University School of Medicine, 1 Children's Pl, St Louis, MO 63110, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Koester
authors.affiliation: Washington University School of Medicine, 1 Children's Pl, St Louis, MO 63110, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Sides
authors.affiliation: Washington University School of Medicine, 1 Children's Pl, St Louis, MO 63110, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lenke
authors.affiliation: Washington University School of Medicine, 1 Children's Pl, St Louis, MO 63110, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Bridwell
authors.affiliation: Consulting Orthopedists, 4708 Alliance Boulevard, Suite 810, Plano, TX 75093, USA.
authors.forename: Mike
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Miami Children's Hospital, 3601 NW 107th Ave, Miami, FL 33178, USA.
authors.forename: Harry L
authors.initials: HL
authors.lastname: Shufflebarger
keywords: Adolescent idiopathic scoliosis; Anterior vs. posterior; Cobb angle; Instrumentation; Lenke 5C