Ten-year follow-up of Lenke 5 curves treated with spinal fusion

May 10, 2022

doi: 10.1007/s43390-022-00512-w.

Online ahead of print.

Affiliations

¹ Clinical Practice Group in Orthopaedics, Children’s Healthcare of Atlanta, 1400 Tullie Rd NE, Atlanta, GA, 30329, USA. [email protected].
² Rady Children’s Hospital, San Diego, CA, USA.
³ The Mayo Clinic, Rochester, MN, USA.
⁴ Sainte-Justine Hospital for Children, Montreal, QC, Canada.
⁵ Mount Sinai Hospital, New York, NY, USA.
⁶ Seattle Children’s Hospital, Seattle, WA, USA.
⁷ Colorado Children’s Hospital, Aurora, CO, USA.

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Nicholas D Fletcher et al.

Spine Deform.

2022.

doi: 10.1007/s43390-022-00512-w.

Online ahead of print.

Affiliations

¹ Clinical Practice Group in Orthopaedics, Children’s Healthcare of Atlanta, 1400 Tullie Rd NE, Atlanta, GA, 30329, USA. [email protected].
² Rady Children’s Hospital, San Diego, CA, USA.
³ The Mayo Clinic, Rochester, MN, USA.
⁴ Sainte-Justine Hospital for Children, Montreal, QC, Canada.
⁵ Mount Sinai Hospital, New York, NY, USA.
⁶ Seattle Children’s Hospital, Seattle, WA, USA.
⁷ Colorado Children’s Hospital, Aurora, CO, USA.

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Abstract

Introduction:

Patients with surgically treated Lenke 5 curves require at least partial fusion of the lumbar spine. The implications of lumbar fusion remain unknown as long-term follow-up is sparse.

Methods:

A retrospective review of a prospectively collected registry of patients with Lenke 5 curves treated with spinal fusion was performed. Clinical and radiographic outcomes as well as SRS-22 scores were collected at 2- and 10-year follow-up.

Results:

54 of 247 available patients met all inclusion criteria [26 treated with posterior spinal fusion (PSF) and 28 with anterior spinal fusion (ASF)]. Preoperative lumbar curve magnitude was 45.1 ± 8.4° and corrected to 14.0 ± 7.2° (p < 0.001). A 3.3 ± 7.3° increase in curve size was noted at final follow-up (p < 0.008) with 20.3% of patients having a loss of correction (LOC)of 10° or more. Thoracic curve correction and kyphosis were stable at 10-year follow-up. End vertebrae angulation improved from 11.2 ± 23.2° to 0.96 ± 6.4° (p = 0.004) and translation improved from 2.5 ± 2.9 to 0.92 ± 1.5 cm (p = 0.008) with no LOC. Disc wedging below the lower instrumented vertebrae increased from 0.3 ± 4.9° to 2.8 ± 4.4° (p < 0.001) with no change at 10 years. SRS-22 self-image and satisfaction improved from post-operative to final follow-up. No patient required a second operation.

Conclusions:

Both ASF and PSF showed durable results at 10-year follow-up with no obvious difference between approaches. 20% of patients had a LOC > 10°; this did not correlate with pain or need for revision surgery. Disc wedging was stable. Selection of LIV did not correlate with pain scores.

Level of evidence:

Level III.

Keywords:

Adolescent idiopathic scoliosis; Lenke 5; Spinal fusion; Thoracolumbar.

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