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Purpose <p>To investigate the effect of preoperative coronal balance patterns on the clinical outcome of Lenke 5&#xa0;C patients with poor thoracic curve compensation ability following different fusion strategies.</p> Methods <p>Poor thoracic compensatory ability was defined as a thoracic cobb angle between 15° and 25° on supine bending films. Coronal balance patterns were classified as Type A (coronal balance distance (CBD)&lt;20&#xa0;mm), Type B (CBD &gt; 20&#xa0;mm and C7 plumbline (C7PL) shifted to concave side of main curve), and Type C (CBD &gt; 20&#xa0;mm and C7PL shifted to convex side of main curve), based on CBD and position of C7PL relative to main curve. Patients with preoperative Type C were classified into the Group Type C1(underwent selective fusion) and the Group Type C2(underwent non-selective fusion), and patients with preoperative Type A all underwent selective fusion surgery. Quality of life in preoperative Type C patients following different fusion strategies was assessed using the SRS-22 scale.</p> Results <p>Patients with preoperative Type C coronal pattern and poor thoracic compensatory ability showed a higher likelihood of thoracic curve progression after selective fusion surgery compared to Type A patients (48.7% vs. 20.9%, <i>P</i> = 0.007). In the Type A group, only 4.65% experienced thoracic curve progression exceeding 10°, while in the Type C1 group, this percentage was 21.95%. Additionally, at the last follow-up, 93.1% of Type A patients maintained good coronal balance, whereas 17.1% of Type C1 patients still had coronal imbalance. Type C2 patients who underwent non-selective fusion showed improved thoracic curvature from 34.86 ± 4.64° to 11.14 ± 4.30°, which was well maintained during follow-up. At the last follow-up, only 1 of 35 (2.8%) patients retained the Type C coronal pattern. The SRS-22 questionnaire showed that in Lenke 5&#xa0;C AIS patients with preoperative Type C, the Type C2 group had significantly higher pain (4.33±0.51 vs. 3.87±0.55, <i>P</i> = 0.003) and self-image scores (4.88±0.10 vs. 4.55±0.50, <i>P</i> = 0.020) compared to the Type C1 group.</p> Conclusion <p>For Lenke 5&#xa0;C AIS patients exhibiting poor thoracic compensatory ability and preoperative Type C coronal imbalance, selective fusion demonstrated higher risks of proximal thoracic curve progression compared and inferior coronal balance restoration during follow-up. These findings suggest cautious consideration for preoperative coronal pattern and poor thoracic compensatory ability in Lenke 5&#xa0;C AIS patients when planning surgery strategies.</p>

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Optimizing surgical strategy in Lenke 5 C AIS patients with poor thoracic compensatory ability: is there a role of coronal imbalance?

  • 期刊论文

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  • 发表日期：

    2026年4月27日

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  • Chunxiao Chen,
  • Qiang Liu,
  • Yinyu Fang,
  • Jie Li,
  • Xiaodong Qin,
  • Benlong Shi,
  • Saihu Mao,
  • Yong Qiu,
  • Zezhang Zhu,
  • Zhen Liu

摘要

Purpose

To investigate the effect of preoperative coronal balance patterns on the clinical outcome of Lenke 5 C patients with poor thoracic curve compensation ability following different fusion strategies.

Methods

Poor thoracic compensatory ability was defined as a thoracic cobb angle between 15° and 25° on supine bending films. Coronal balance patterns were classified as Type A (coronal balance distance (CBD)<20 mm), Type B (CBD > 20 mm and C7 plumbline (C7PL) shifted to concave side of main curve), and Type C (CBD > 20 mm and C7PL shifted to convex side of main curve), based on CBD and position of C7PL relative to main curve. Patients with preoperative Type C were classified into the Group Type C1(underwent selective fusion) and the Group Type C2(underwent non-selective fusion), and patients with preoperative Type A all underwent selective fusion surgery. Quality of life in preoperative Type C patients following different fusion strategies was assessed using the SRS-22 scale.

Results

Patients with preoperative Type C coronal pattern and poor thoracic compensatory ability showed a higher likelihood of thoracic curve progression after selective fusion surgery compared to Type A patients (48.7% vs. 20.9%, P = 0.007). In the Type A group, only 4.65% experienced thoracic curve progression exceeding 10°, while in the Type C1 group, this percentage was 21.95%. Additionally, at the last follow-up, 93.1% of Type A patients maintained good coronal balance, whereas 17.1% of Type C1 patients still had coronal imbalance. Type C2 patients who underwent non-selective fusion showed improved thoracic curvature from 34.86 ± 4.64° to 11.14 ± 4.30°, which was well maintained during follow-up. At the last follow-up, only 1 of 35 (2.8%) patients retained the Type C coronal pattern. The SRS-22 questionnaire showed that in Lenke 5 C AIS patients with preoperative Type C, the Type C2 group had significantly higher pain (4.33±0.51 vs. 3.87±0.55, P = 0.003) and self-image scores (4.88±0.10 vs. 4.55±0.50, P = 0.020) compared to the Type C1 group.

Conclusion

For Lenke 5 C AIS patients exhibiting poor thoracic compensatory ability and preoperative Type C coronal imbalance, selective fusion demonstrated higher risks of proximal thoracic curve progression compared and inferior coronal balance restoration during follow-up. These findings suggest cautious consideration for preoperative coronal pattern and poor thoracic compensatory ability in Lenke 5 C AIS patients when planning surgery strategies.