Outcomes of Lenke V adolescent idiopathic scoliosis treated by anterior correction and fusion

Abstract

Background: Adolescent idiopathic scoliosis (AIS) surgical correction is required for curves progressing to exceed 40–45°, with the option of an anterior and posterior approach. Anterior correction may allow fewer lumbar levels to be fused, but there are intuitive concerns regarding diaphragmatic and pulmonary consequences, as well as overall safety. The main hypothesis of the study was that the radiographically determined pulmonary function of AIS patients who underwent anterior correction improved between pre- and postoperative assessments.

Methods: A retrospective study was conducted on 46 consecutive patients who underwent anterior correction of AIS. Among the usual data collected (Cobb angle, sagittal balance angles, demographic data, clinical scores), pre- and postoperative measurement of T1-diaphragm/T1T12 and AVDR (apical vertebra deviation ratio) ratios were used to evaluate pulmonary function.

Results: The mean correction of the Cobb angle was 53° ± 12 to 15° ± 12. The AVDR improved significantly (p < 0.001) from 0.18 to 0.07 postoperatively. The T1-D/T1T12 ratio (p = 0.57) was unchanged. Scoliosis Research Society-22 (SRS-22) scoring improved for all sub-components at follow-up.

Conclusion: Anterior correction for lumbar scoliosis provides an effective curve correction and improves the AVDR ratio, which correlates to pulmonary function (forced and total lung capacities). The unchanged T1-D/T1T12 ratio confirms no radiographic deterioration of the lung fields with diaphragmatic takedown and repair.

Level of evidence: 4