Ten-year outcomes of selective fusions for adolescent idiopathic scoliosis

Craig Louer, Burt Yaszay, Madeline Cross, Carrie E. Bartley, Tracey P. Bastrom, Suken A. Shah, Baron Lonner, Patrick J. Cahill, Amer Samdani, Vidyadhar V. Upasani, Peter O. Newton

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28 Scopus citations


Background:Selective fusions of the structural curve remain a common treatment strategy for adolescent idiopathic scoliosis, yet long-term outcomes are not well-understood. The purpose of this study was to report 10-year prospective radiographic and patient-rated outcomes of selective fusions of the main thoracic (MT) or thoracolumbar/lumbar (TL/L) curve, with particular attention to the behavior of the uninstrumented, compensatory curve.Methods:A prospectively collected multicenter database was used to identify patients who had been followed regularly for least 10 years after a selective MT or TL/L fusion for adolescent idiopathic scoliosis. Interval radiographs were evaluated for coronal and sagittal Cobb angles as well as overall coronal balance. Scores on the Scoliosis Research Society Questionnaire (SRS-24) were catalogued and evaluated. Radiographic outcomes and SRS-24 scores were compared between preoperative and postoperative time points using repeated-measures analysis of variance. Individual patient records were screened for recent curve progression of >5°, and these cases were methodically evaluated.Results:Fifty-one patients with selective fusions (21 MT and 30 TL/L) for adolescent idiopathic scoliosis who had been followed for at least 10 years were identified. The instrumented MT and TL/L curves were corrected by an average of 51% and 60%, respectively, at 10 years. The uninstrumented, compensatory curves had gradual spontaneous correction that approached the magnitude of the fused curve at 5 years postoperatively, with the correction maintained at 10 years. This led to excellent coronal balance. A subgroup of patients had recent progression of the primary curve adjacent to the prior fusion or within the instrumented segments, resulting in a compensatory progression of the uninstrumented curve. On the whole, SRS scores did not decrease during follow-up, and no patient had secondary operations.Conclusions:Selective fusion of a primary thoracic or lumbar curve in properly selected patients with adolescent idiopathic scoliosis will result in spontaneous correction of the uninstrumented curve and a durable result for at least 10 years.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)761-770
Number of pages10
JournalJournal of Bone and Joint Surgery
Issue number9
StatePublished - 1 May 2019


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