Is Lenke Rule About Selective Thoracic Fusion Applicable for Younger Adult Idiopathic Scoliosis Under 40 Years of Age: Comparison With Adolescent Patients

摘要

Study Design: Retrospective study. Objective To evaluate the surgical outcomes of younger adult idiopathic scoliosis patients (YAdIS) with selective thoracic fusion by comparing them with adolescent idiopathic scoliosis (AIS). @@@ Methods: Seventy-two idiopathic scoliosis patients (36 adults and 36 adolescents) treated by posterior-only all-pedicle screw technique were retrospective reviewed and matched by fusion levels. Radiographic parameters were evaluated preoperatively, postoperatively, and at final follow-up. Operating time, blood loss, transfusion, and complications were noted. The clinical outcome was assessed by the Scoliosis Research Society-22 questionnaire (SRS-22). @@@ Results: The major thoracic curves in YAdIS and AIS groups were 56.3 degrees +/- 9.7 degrees, 53.3 degrees +/- 10.1 degrees and corrected to 17.2 degrees +/- 7.3 degrees, 14.9 degrees +/- 7.5 degrees respectively without significant difference in correction rate (69.3% vs 72.0%). For the lumbar curve, Cobb angles in 2 groups were 35.6 degrees +/- 10.1 degrees and 31.4 +/- 9.2 degrees preoperatively, and were spontaneously corrected to 18.5 degrees +/- 9.0 degrees and 12.6 degrees +/- 8.2 degrees.Correction rates were 48.0% and 59.8% (P < .05). Preoperative and postoperative coronal vertebra alignments (CVA) in the YAdIS group were 20.6 +/- 9.7 mm and 16.8 +/- 7.9 mm (P > .05), while in the AIS group was 17.8 +/- 10.5 mm and 9.7 +/- 8.3 mm (P < .05). However, sagittal parameters showed significant improvements in thoracic kyphosis in both groups (P < .05). Complication rates were 25% vs 11.1% (P = .13) with no significant difference. Preoperative SRS-22 was worse in the YAdIS group than AIS group. All the scores were significantly improved postoperatively in the YAdIS group. However, in the AIS group, only SRS scores improved significantly. @@@ Conclusions: YAdIS can also be treated very well with selective thoracic fusion based on the Lenke rule used for AIS.

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