A comparison of patients with adolescent idiopathic scoliosis and Lenke C-type lumbar curves treated with selective thoracic fusion vs non-selective fusion: a 10-year follow-up study

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发表日期：

2026年6月10日

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Nicholas D. Fletcher,
Tracey P. Bryan,
Suken A. Shah,
Stefan Parent,
A. Noelle Larson,
Michelle A. Marks,
Michael P. Kelly,
A. Noelle Larson,
Aaron Buckland,
Ahmet Alanay,
Amer Samdani,
Amit Jain,
Baron Lonner,
Benjamin Roye,
Burt Yaszay,
Caglar Yilgor,
Dan Hoernschmeyer,
Daniel Hedequist,
Daniel Sucato,
David Clements,
Firoz Miyanji,
Harry Shufflebarger,
Jack Flynn,
Jason Anari,
Jaysson Brooks,
Jean Marc Mac Thiong,
Jenn Bauer,
Josh Murphy,
Joshua Pahys,
Keith Bachmann,
Kevin Neal,
Lawrence Haber,
Lawrence Lenke,
Mark Erickson,
Michael Glotzbecker,
Michael Kelly,
Michael Vitale,
Michelle Marks,
Munish Gupta,
Nicholas Fletcher,
Patrick Cahill,
Paul Sponseller,
Peter Gabos,
Peter Newton,
Randal Betz,
Robert H. Cho,
Stefan Parent,
Stephen George,
Steven Hwang,
Suken Shah,
Sumeet Garg,
Tom Errico,
Vidyadhar Upasani

摘要

Introduction

Selective thoracic fusion (STF) of scoliosis due to adolescent idiopathic scoliosis in patients with flexible lumbar curves is a desirable option to preserve lumbar motion segments. No prior studies have evaluated clinical, radiographic and patient-reported outcomes of this technique at 10-year follow-up.

Methods

A review of a prospectively collected multicenter database was performed for patients with Lenke 1C, 2C, 3C or 4C-type scoliosis curves treated with either STF (L1 LIV and proximal) vs non-selective fusion of both curves (NSF) (L2 LIV and distal) who had a minimum of 10-year follow-up. Baseline demographics, spinal deformity characteristics, complications, lumbar motion (forward flexion and lateral bending), and SRS-22 patient reported outcomes scores were compared at first post operative, 2-year, and 10-year follow-up.

Results

52 NSF and 45 STF (97 total) patients were followed for 10 years after surgery. Preoperative main thoracic (MT, 62 ± 11° NSF vs 56 ± 10° STF, p = 0.02) and thoracolumbar ( TL, 52 ± 11° NSF vs 44 ± 17° STF, p < 0.001) curves were larger in the NSF group. At 10-year follow-up, patients with NSF had smaller residual lumbar curves (17° vs 23°, p < 0.001), and no difference in forward flexion or SRS-22 scores. Lateral flexion was decreased in NSF patients (p < 0.05). More NSF patients reached clinically meaningful improvement in self-image (83% vs 60%, p = 0.02); however, there were no differences in any other subdomains of the SRS-22. There was no difference in complications or reoperations between groups.

Conclusions

STF was associated with a larger residual lumbar curve at 10-year follow-up. NSF patients less lateral spinal motion but were more likely to report better self-image after surgery.

Significance

Ten-year follow-up data on patients treated with two different techniques for Lenke C AIS demonstrates meaningful differences for patient decision making. STF results in better motion with slightly larger residual lumbar curves and marginally lower self-image scores, while NSF results in better self-image and lumbar curvature correction and similar complication profiles.