Preoperative factors associated with optimal outcomes of selective thoracic fusion at 5 years

Harms Study Group

doi:10.1007/s43390-022-00500-0

Preoperative factors associated with optimal outcomes of selective thoracic fusion at 5 years

Harms Study Group

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: Prior work identified optimal outcomes at 2 years following selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS) but it is unclear whether these published predictors represent what is required to achieve an optimal outcome with further time and potential growth. The purpose of this study was to determine the preoperative factors associated with optimal outcome of STF for AIS at 5 years. Methods: Patients with primary thoracic AIS (Lenke 1–4C curves) who underwent a STF and had minimum 5 years of follow-up were included. Optimal postoperative outcomes for a STF included a deformity-flexibility quotient (DFQ) < 4, lumbar curve < 26°, lumbar correction > 37%, C7-CSVL < 2 cm, lumbar prominence < 5°, and trunk shift < 1.5 cm. These outcomes were used to determine whether adhering to published recommendations for STF increased the likelihood of obtaining an optimal outcome at 5 years, which included: preoperative lumbar curve < 45°, lumbar bend < 25°, apical vertebral translation ratio > 1.2, and thoracic/thoracolumbar Cobb ratio > 1.2. Results: 127 patients met inclusion. A preoperative lumbar curve < 45° was associated with an increased likelihood of achieving three of the optimal outcomes: DFQ < 4, lumbar curve < 26°, and lumbar prominence < 5°. Following the 25° bend rule resulted in two optimal outcomes, while Cobb ratio > 1.2 was only associated with one optimal outcome. AVT > 1.2 was not significantly associated with any optimal outcome measures. Conclusion: This study found that at 5 years, performing a STF when there is a preoperative lumbar Cobb < 45° remained the best guideline for increasing the likelihood of an optimal outcome.

Original language	English
Pages (from-to)	1117-1122
Number of pages	6
Journal	Spine deformity
Volume	10
Issue number	5
DOIs	https://doi.org/10.1007/s43390-022-00500-0
State	Published - Sep 2022

Keywords

Adolescent idiopathic scoliosis
Lumbar curve
Outcomes
Selective thoracic fusion

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10.1007/s43390-022-00500-0

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@article{cb828498488045eeaf57fce248165d58,

title = "Preoperative factors associated with optimal outcomes of selective thoracic fusion at 5 years",

abstract = "Purpose: Prior work identified optimal outcomes at 2 years following selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS) but it is unclear whether these published predictors represent what is required to achieve an optimal outcome with further time and potential growth. The purpose of this study was to determine the preoperative factors associated with optimal outcome of STF for AIS at 5 years. Methods: Patients with primary thoracic AIS (Lenke 1–4C curves) who underwent a STF and had minimum 5 years of follow-up were included. Optimal postoperative outcomes for a STF included a deformity-flexibility quotient (DFQ) < 4, lumbar curve < 26°, lumbar correction > 37%, C7-CSVL < 2 cm, lumbar prominence < 5°, and trunk shift < 1.5 cm. These outcomes were used to determine whether adhering to published recommendations for STF increased the likelihood of obtaining an optimal outcome at 5 years, which included: preoperative lumbar curve < 45°, lumbar bend < 25°, apical vertebral translation ratio > 1.2, and thoracic/thoracolumbar Cobb ratio > 1.2. Results: 127 patients met inclusion. A preoperative lumbar curve < 45° was associated with an increased likelihood of achieving three of the optimal outcomes: DFQ < 4, lumbar curve < 26°, and lumbar prominence < 5°. Following the 25° bend rule resulted in two optimal outcomes, while Cobb ratio > 1.2 was only associated with one optimal outcome. AVT > 1.2 was not significantly associated with any optimal outcome measures. Conclusion: This study found that at 5 years, performing a STF when there is a preoperative lumbar Cobb < 45° remained the best guideline for increasing the likelihood of an optimal outcome.",

keywords = "Adolescent idiopathic scoliosis, Lumbar curve, Outcomes, Selective thoracic fusion",

author = "{Harms Study Group} and Lindgren, {Amelia M.} and Bastrom, {Tracey P.} and Bartley, {Carrie E.} and Samdani, {Amer F.} and Shah, {Suken A.} and Firoz Miyanji and Cahill, {Patrick J.} and Upasani, {Vidyadhar V.} and Newton, {Peter O.} and Aaron Buckland and Amer Samdani and Amit Jain and Baron Lonner and Benjamin Roye and Burt Yaszay and Chris Reilly and Daniel Hedequist and Daniel Sucato and David Clements and Harry Shufflebarger and Jack Flynn and John Asghar and {Mac Thiong}, {Jean Marc} and Joshua Pahys and Juergen Harms and Keith Bachmann and Lawrence Lenke and Lori Karol and Mark Abel and Mark Erickson and Michael Glotzbecker and Michael Kelly and Michael Vitale and Michelle Marks and Munish Gupta and Nicholas Fletcher and Noelle Larson and Patrick Cahill and Paul Sponseller and Peter Gabos and Peter Newton and Peter Sturm and Randal Betz and Stefan Parent and Stephen George and Steven Hwang and Suken Shah and Sumeet Garg and Tom Errico and Vidyadhar Upasani and Burt Yaszay",

note = "Funding Information: This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration. Harms Study Group Investigators: Aaron Buckland, MD; Royal Children{\textquoteright}s Hospital—Melbourne Australia. Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia. Amit Jain, MD; Johns Hopkins Hospital. Baron Lonner, MD; Mount Sinai Hospital. Benjamin Roye, MD; Columbia University. Burt Yaszay, MD; Seattle Children{\textquoteright}s Hospital. Chris Reilly, MD; BC Children{\textquoteright}s Hospital. Daniel Hedequist, MD; Boston Children{\textquoteright}s Hospital. Daniel Sucato, MD; Texas Scottish Rite Hospital. David Clements, MD; Cooper Bone & Joint Institute New Jersey. Firoz Miyanji, MD; BC Children{\textquoteright}s Hospital. Harry Shufflebarger, MD; Paley Orthopedic & Spine Institute. Jack Flynn, MD; Children{\textquoteright}s Hospital of Philadelphia. John Asghar, MD; Paley Orthopedic & Spine Institute. Jean Marc Mac Thiong, MD; CHU Sainte-Justine. Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia. Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad. Keith Bachmann, MD; University of Virginia. Lawrence Lenke, MD; Columbia University. Lori Karol, MD; Children{\textquoteright}s Hospital, Denver Colorado. Mark Abel, MD; University of Virginia. Mark Erickson, MD; Children{\textquoteright}s Hospital, Denver Colorado. Michael Glotzbecker, MD; Rainbow Children{\textquoteright}s Hospital, Cleveland. Michael Kelly, MD; Washington University. Michael Vitale, MD; Columbia University. Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation. Munish Gupta, MD; Washington University. Nicholas Fletcher, MD; Emory University. Noelle Larson, MD; Mayo Clinic Rochester Minnesota. Patrick Cahill, MD; Children{\textquoteright}s Hospital of Philadelphia. Paul Sponseller, MD; Johns Hopkins Hospital. Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children. Peter Newton, MD; Rady Children{\textquoteright}s Hospital. Peter Sturm, MD; Cincinnati Children{\textquoteright}s Hospital. Randal Betz, MD; Institute for Spine & Scoliosis. Stefan Parent, MD: CHU Sainte-Justine. Stephen George, MD; Nicklaus Children's Hospital. Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia. Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children. Sumeet Garg, MD; Children{\textquoteright}s Hospital, Denver Colorado. Tom Errico, MD; Nicklaus Children's Hospital. Vidyadhar Upasani, MD; Rady Children{\textquoteright}s Hospital. Funding Information: Amelia M. Lindgren, MD, During the Conduct of the Study: None/No funding received. Outside the Submitted Work: None/No funding received. Tracey P. Bastrom, MA, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation to her institution. Outside the Submitted Work: grants from Setting Scoliosis Straight Foundation to her institution. Carrie E. Bartley, MA, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation to her institution. Outside the Submitted Work: grants from Setting Scoliosis Straight Foundation to her institution. Amer F. Samdani, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet. Suken A. Shah, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from DePuy Synthes Spine. Firoz Miyanji, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from Depuy Synthes Spine, personal fees from Stryker Spine, personal fees from Zimmer Biomet. Patrick J. Cahill, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from NuVasive, other from Journal of Bone and Joint Surgery—America, other from Pediatric Orthopedic Society of North America, from Scoliosis Research Society, other from Spine Deformity. Vidyadhar V. Upasani, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from OrthoPediatrics, personal fees from DePuy Synthes Spine, grants from EOS Imaging, grants from nView, personal fees from Orthofix, personal fees from Wolter Kluwer Health. Peter O. Newton, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: grants and other from Setting Scoliosis Straight Foundation, other from Rady Children's Specialists, grants, personal fees and non-financial support from DePuy Synthes Spine, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, grants from NuVasive, other from Electrocore, personal fees from Cubist, other from International Pediatric Orthopedic Think Tank, grants, non-financial support and other from Orthopediatrics, grants, personal fees and non-financial support from Stryker/K2M, grants and non-financial support from Alphatech, grants from Mazor Robotics, personal fees from MiRus, personal fees from Globus Medical, personal fees from Pacira, from Scoliosis Research Society. In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) licensed to DePuy Spine, Inc., a patent Screw placement guide (7981117) licensed to DePuy Spine, Inc., a patent Compressor for use in minimally invasive surgery (7189244) licensed to DePuy Spine, Inc., and a patent Posterior spinal fixation pending to K2M. Harms Study Group: During the Conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: grants from Setting Scoliosis Straight Foundation. Burt Yaszay, MD, During the Conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted work: grants and personal fees from DePuy Synthes Spine, grants and personal fees from NuVasive, personal fees from Medtronic, grants and personal fees from Orthopediatrics, grants and personal fees from K2M/Stryker, personal fees from Globus, grants from Setting Scoliosis Straight Foundation, personal fees from Biogen. In addition, Dr. Yaszay has a patent K2M/Stryker with royalties paid. Funding Information: This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration. Harms Study Group Investigators: Aaron Buckland, MD; Royal Children{\textquoteright}s Hospital—Melbourne Australia. Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia. Amit Jain, MD; Johns Hopkins Hospital. Baron Lonner, MD; Mount Sinai Hospital. Benjamin Roye, MD; Columbia University. Burt Yaszay, MD; Seattle Children{\textquoteright}s Hospital. Chris Reilly, MD; BC Children{\textquoteright}s Hospital. Daniel Hedequist, MD; Boston Children{\textquoteright}s Hospital. Daniel Sucato, MD; Texas Scottish Rite Hospital. David Clements, MD; Cooper Bone & Joint Institute New Jersey. Firoz Miyanji, MD; BC Children{\textquoteright}s Hospital. Harry Shufflebarger, MD; Paley Orthopedic & Spine Institute. Jack Flynn, MD; Children{\textquoteright}s Hospital of Philadelphia. John Asghar, MD; Paley Orthopedic & Spine Institute. Jean Marc Mac Thiong, MD; CHU Sainte-Justine. Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia. Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad. Keith Bachmann, MD; University of Virginia. Lawrence Lenke, MD; Columbia University. Lori Karol, MD; Children{\textquoteright}s Hospital, Denver Colorado. Mark Abel, MD; University of Virginia. Mark Erickson, MD; Children{\textquoteright}s Hospital, Denver Colorado. Michael Glotzbecker, MD; Rainbow Children{\textquoteright}s Hospital, Cleveland. Michael Kelly, MD; Washington University. Michael Vitale, MD; Columbia University. Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation. Munish Gupta, MD; Washington University. Nicholas Fletcher, MD; Emory University. Noelle Larson, MD; Mayo Clinic Rochester Minnesota. Patrick Cahill, MD; Children{\textquoteright}s Hospital of Philadelphia. Paul Sponseller, MD; Johns Hopkins Hospital. Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children. Peter Newton, MD; Rady Children{\textquoteright}s Hospital. Peter Sturm, MD; Cincinnati Children{\textquoteright}s Hospital. Randal Betz, MD; Institute for Spine & Scoliosis. Stefan Parent, MD: CHU Sainte-Justine. Stephen George, MD; Nicklaus Children's Hospital. Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia. Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children. Sumeet Garg, MD; Children{\textquoteright}s Hospital, Denver Colorado. Tom Errico, MD; Nicklaus Children's Hospital. Vidyadhar Upasani, MD; Rady Children{\textquoteright}s Hospital. Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Scoliosis Research Society.",

year = "2022",

month = sep,

doi = "10.1007/s43390-022-00500-0",

language = "English",

volume = "10",

pages = "1117--1122",

journal = "Spine Deformity",

issn = "2212-134X",

number = "5",

}

TY - JOUR

T1 - Preoperative factors associated with optimal outcomes of selective thoracic fusion at 5 years

AU - Harms Study Group

AU - Lindgren, Amelia M.

AU - Bastrom, Tracey P.

AU - Bartley, Carrie E.

AU - Samdani, Amer F.

AU - Shah, Suken A.

AU - Miyanji, Firoz

AU - Cahill, Patrick J.

AU - Upasani, Vidyadhar V.

AU - Newton, Peter O.

AU - Buckland, Aaron

AU - Samdani, Amer

AU - Jain, Amit

AU - Lonner, Baron

AU - Roye, Benjamin

AU - Yaszay, Burt

AU - Reilly, Chris

AU - Hedequist, Daniel

AU - Sucato, Daniel

AU - Clements, David

AU - Shufflebarger, Harry

AU - Flynn, Jack

AU - Asghar, John

AU - Mac Thiong, Jean Marc

AU - Pahys, Joshua

AU - Harms, Juergen

AU - Bachmann, Keith

AU - Lenke, Lawrence

AU - Karol, Lori

AU - Abel, Mark

AU - Erickson, Mark

AU - Glotzbecker, Michael

AU - Kelly, Michael

AU - Vitale, Michael

AU - Marks, Michelle

AU - Gupta, Munish

AU - Fletcher, Nicholas

AU - Larson, Noelle

AU - Cahill, Patrick

AU - Sponseller, Paul

AU - Gabos, Peter

AU - Newton, Peter

AU - Sturm, Peter

AU - Betz, Randal

AU - Parent, Stefan

AU - George, Stephen

AU - Hwang, Steven

AU - Shah, Suken

AU - Garg, Sumeet

AU - Errico, Tom

AU - Upasani, Vidyadhar

AU - Yaszay, Burt

N1 - Funding Information: This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration. Harms Study Group Investigators: Aaron Buckland, MD; Royal Children’s Hospital—Melbourne Australia. Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia. Amit Jain, MD; Johns Hopkins Hospital. Baron Lonner, MD; Mount Sinai Hospital. Benjamin Roye, MD; Columbia University. Burt Yaszay, MD; Seattle Children’s Hospital. Chris Reilly, MD; BC Children’s Hospital. Daniel Hedequist, MD; Boston Children’s Hospital. Daniel Sucato, MD; Texas Scottish Rite Hospital. David Clements, MD; Cooper Bone & Joint Institute New Jersey. Firoz Miyanji, MD; BC Children’s Hospital. Harry Shufflebarger, MD; Paley Orthopedic & Spine Institute. Jack Flynn, MD; Children’s Hospital of Philadelphia. John Asghar, MD; Paley Orthopedic & Spine Institute. Jean Marc Mac Thiong, MD; CHU Sainte-Justine. Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia. Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad. Keith Bachmann, MD; University of Virginia. Lawrence Lenke, MD; Columbia University. Lori Karol, MD; Children’s Hospital, Denver Colorado. Mark Abel, MD; University of Virginia. Mark Erickson, MD; Children’s Hospital, Denver Colorado. Michael Glotzbecker, MD; Rainbow Children’s Hospital, Cleveland. Michael Kelly, MD; Washington University. Michael Vitale, MD; Columbia University. Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation. Munish Gupta, MD; Washington University. Nicholas Fletcher, MD; Emory University. Noelle Larson, MD; Mayo Clinic Rochester Minnesota. Patrick Cahill, MD; Children’s Hospital of Philadelphia. Paul Sponseller, MD; Johns Hopkins Hospital. Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children. Peter Newton, MD; Rady Children’s Hospital. Peter Sturm, MD; Cincinnati Children’s Hospital. Randal Betz, MD; Institute for Spine & Scoliosis. Stefan Parent, MD: CHU Sainte-Justine. Stephen George, MD; Nicklaus Children's Hospital. Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia. Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children. Sumeet Garg, MD; Children’s Hospital, Denver Colorado. Tom Errico, MD; Nicklaus Children's Hospital. Vidyadhar Upasani, MD; Rady Children’s Hospital. Funding Information: Amelia M. Lindgren, MD, During the Conduct of the Study: None/No funding received. Outside the Submitted Work: None/No funding received. Tracey P. Bastrom, MA, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation to her institution. Outside the Submitted Work: grants from Setting Scoliosis Straight Foundation to her institution. Carrie E. Bartley, MA, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation to her institution. Outside the Submitted Work: grants from Setting Scoliosis Straight Foundation to her institution. Amer F. Samdani, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet. Suken A. Shah, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from DePuy Synthes Spine. Firoz Miyanji, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from Depuy Synthes Spine, personal fees from Stryker Spine, personal fees from Zimmer Biomet. Patrick J. Cahill, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from NuVasive, other from Journal of Bone and Joint Surgery—America, other from Pediatric Orthopedic Society of North America, from Scoliosis Research Society, other from Spine Deformity. Vidyadhar V. Upasani, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from OrthoPediatrics, personal fees from DePuy Synthes Spine, grants from EOS Imaging, grants from nView, personal fees from Orthofix, personal fees from Wolter Kluwer Health. Peter O. Newton, MD, During the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: grants and other from Setting Scoliosis Straight Foundation, other from Rady Children's Specialists, grants, personal fees and non-financial support from DePuy Synthes Spine, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, grants from NuVasive, other from Electrocore, personal fees from Cubist, other from International Pediatric Orthopedic Think Tank, grants, non-financial support and other from Orthopediatrics, grants, personal fees and non-financial support from Stryker/K2M, grants and non-financial support from Alphatech, grants from Mazor Robotics, personal fees from MiRus, personal fees from Globus Medical, personal fees from Pacira, from Scoliosis Research Society. In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) licensed to DePuy Spine, Inc., a patent Screw placement guide (7981117) licensed to DePuy Spine, Inc., a patent Compressor for use in minimally invasive surgery (7189244) licensed to DePuy Spine, Inc., and a patent Posterior spinal fixation pending to K2M. Harms Study Group: During the Conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: grants from Setting Scoliosis Straight Foundation. Burt Yaszay, MD, During the Conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted work: grants and personal fees from DePuy Synthes Spine, grants and personal fees from NuVasive, personal fees from Medtronic, grants and personal fees from Orthopediatrics, grants and personal fees from K2M/Stryker, personal fees from Globus, grants from Setting Scoliosis Straight Foundation, personal fees from Biogen. In addition, Dr. Yaszay has a patent K2M/Stryker with royalties paid. Funding Information: This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration. Harms Study Group Investigators: Aaron Buckland, MD; Royal Children’s Hospital—Melbourne Australia. Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia. Amit Jain, MD; Johns Hopkins Hospital. Baron Lonner, MD; Mount Sinai Hospital. Benjamin Roye, MD; Columbia University. Burt Yaszay, MD; Seattle Children’s Hospital. Chris Reilly, MD; BC Children’s Hospital. Daniel Hedequist, MD; Boston Children’s Hospital. Daniel Sucato, MD; Texas Scottish Rite Hospital. David Clements, MD; Cooper Bone & Joint Institute New Jersey. Firoz Miyanji, MD; BC Children’s Hospital. Harry Shufflebarger, MD; Paley Orthopedic & Spine Institute. Jack Flynn, MD; Children’s Hospital of Philadelphia. John Asghar, MD; Paley Orthopedic & Spine Institute. Jean Marc Mac Thiong, MD; CHU Sainte-Justine. Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia. Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad. Keith Bachmann, MD; University of Virginia. Lawrence Lenke, MD; Columbia University. Lori Karol, MD; Children’s Hospital, Denver Colorado. Mark Abel, MD; University of Virginia. Mark Erickson, MD; Children’s Hospital, Denver Colorado. Michael Glotzbecker, MD; Rainbow Children’s Hospital, Cleveland. Michael Kelly, MD; Washington University. Michael Vitale, MD; Columbia University. Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation. Munish Gupta, MD; Washington University. Nicholas Fletcher, MD; Emory University. Noelle Larson, MD; Mayo Clinic Rochester Minnesota. Patrick Cahill, MD; Children’s Hospital of Philadelphia. Paul Sponseller, MD; Johns Hopkins Hospital. Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children. Peter Newton, MD; Rady Children’s Hospital. Peter Sturm, MD; Cincinnati Children’s Hospital. Randal Betz, MD; Institute for Spine & Scoliosis. Stefan Parent, MD: CHU Sainte-Justine. Stephen George, MD; Nicklaus Children's Hospital. Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia. Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children. Sumeet Garg, MD; Children’s Hospital, Denver Colorado. Tom Errico, MD; Nicklaus Children's Hospital. Vidyadhar Upasani, MD; Rady Children’s Hospital. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Scoliosis Research Society.

PY - 2022/9

Y1 - 2022/9

N2 - Purpose: Prior work identified optimal outcomes at 2 years following selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS) but it is unclear whether these published predictors represent what is required to achieve an optimal outcome with further time and potential growth. The purpose of this study was to determine the preoperative factors associated with optimal outcome of STF for AIS at 5 years. Methods: Patients with primary thoracic AIS (Lenke 1–4C curves) who underwent a STF and had minimum 5 years of follow-up were included. Optimal postoperative outcomes for a STF included a deformity-flexibility quotient (DFQ) < 4, lumbar curve < 26°, lumbar correction > 37%, C7-CSVL < 2 cm, lumbar prominence < 5°, and trunk shift < 1.5 cm. These outcomes were used to determine whether adhering to published recommendations for STF increased the likelihood of obtaining an optimal outcome at 5 years, which included: preoperative lumbar curve < 45°, lumbar bend < 25°, apical vertebral translation ratio > 1.2, and thoracic/thoracolumbar Cobb ratio > 1.2. Results: 127 patients met inclusion. A preoperative lumbar curve < 45° was associated with an increased likelihood of achieving three of the optimal outcomes: DFQ < 4, lumbar curve < 26°, and lumbar prominence < 5°. Following the 25° bend rule resulted in two optimal outcomes, while Cobb ratio > 1.2 was only associated with one optimal outcome. AVT > 1.2 was not significantly associated with any optimal outcome measures. Conclusion: This study found that at 5 years, performing a STF when there is a preoperative lumbar Cobb < 45° remained the best guideline for increasing the likelihood of an optimal outcome.

AB - Purpose: Prior work identified optimal outcomes at 2 years following selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS) but it is unclear whether these published predictors represent what is required to achieve an optimal outcome with further time and potential growth. The purpose of this study was to determine the preoperative factors associated with optimal outcome of STF for AIS at 5 years. Methods: Patients with primary thoracic AIS (Lenke 1–4C curves) who underwent a STF and had minimum 5 years of follow-up were included. Optimal postoperative outcomes for a STF included a deformity-flexibility quotient (DFQ) < 4, lumbar curve < 26°, lumbar correction > 37%, C7-CSVL < 2 cm, lumbar prominence < 5°, and trunk shift < 1.5 cm. These outcomes were used to determine whether adhering to published recommendations for STF increased the likelihood of obtaining an optimal outcome at 5 years, which included: preoperative lumbar curve < 45°, lumbar bend < 25°, apical vertebral translation ratio > 1.2, and thoracic/thoracolumbar Cobb ratio > 1.2. Results: 127 patients met inclusion. A preoperative lumbar curve < 45° was associated with an increased likelihood of achieving three of the optimal outcomes: DFQ < 4, lumbar curve < 26°, and lumbar prominence < 5°. Following the 25° bend rule resulted in two optimal outcomes, while Cobb ratio > 1.2 was only associated with one optimal outcome. AVT > 1.2 was not significantly associated with any optimal outcome measures. Conclusion: This study found that at 5 years, performing a STF when there is a preoperative lumbar Cobb < 45° remained the best guideline for increasing the likelihood of an optimal outcome.

KW - Adolescent idiopathic scoliosis

KW - Lumbar curve

KW - Outcomes

KW - Selective thoracic fusion

UR - http://www.scopus.com/inward/record.url?scp=85136355753&partnerID=8YFLogxK

U2 - 10.1007/s43390-022-00500-0

DO - 10.1007/s43390-022-00500-0

M3 - Article

C2 - 35380352

AN - SCOPUS:85136355753

SN - 2212-134X

VL - 10

SP - 1117

EP - 1122

JO - Spine Deformity

JF - Spine Deformity

IS - 5

ER -

Preoperative factors associated with optimal outcomes of selective thoracic fusion at 5 years

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