General Session: Pediatric Spine
Presented by: P. Sudarsan - View Audio/Video Presentation (Members Only)
H. Suthar(1), M. Yarlagadda(1), C. Chikhale(1), M. Jindal(1), S. Hegde(1), P. Sudarsan(2)
(1) Apollo Hospitals, Orthopaedics, Chennai, India
Background: Selective fusion of thoracic and thoracolumbar/lumbar curves in adolescent idiopathic scoliosis is a concept critically debated in the literature.
Purpose: To study the efficacy of selective fusion criteria in Lenke 1C and 5C curves.
Methods: We analyzed the prospective collected data of 22 adolescent idiopathic scoliosis operated at our institute from 2011 to 2015 with mean follow up of 2.4 years. Decision regarding selective fusion were taken based on preoperative radiological parameters. Apical vertebral translation, apical vertebral rotation, cobb angle ratio and kyphosis at different sagittal regions of spine measured and analyzed. Patient were selected for selective fusion on the basis of criteria in literature for selective fusion and patient's guardian informed consent. Radiological parameters like correction of cob angle, coronal decompensation, adding on, and junctional kyphosis were recorded during follow up. Functional outcome were measured with SRS-22 score.
Results: 22 adolescent idiopathic scoliosis with mean age of 15.4 years and 20 patients were females. 14 patients were of Lenke 1C and 8 patients of Lenke 5C curves. Mean major Cobb angle was 67.4 degree and compensatory curve was 40.1 degree and final correction to 18.5 degree for major curve (72.5% correction)and 22.6 degree for compensatory curve(43.6% correction). Cobb correction were maintained during the follow up. One patient with coronal decompensation of 2.4 cm and junction kyphosis of 4 degree noted another one patient. None of them required revision surgery (no adding on). SRS-22 postoperative outcomes showed mean final score of 4.26.
Conclusion: Selective fusion is possible with careful study of preoperative x-rays. Larger prospective multicentre cohort is required for better understanding of selective fusion in scoliosis. Comprehensive selection criteria and patient acceptability are the major concerns of the selective fusion in scoliosis.