The Selective Thoracic Fusion Of Single Thoracic Curve Adolescent Idiopathic Scoliosis

Objective: To prospectively evaluate the strategy of surgery and choice of the fusion segments in thoracic adolescent idiopathic scoliosis (AIS)'s treatment.Methods: Ninety-six patients with single thoracic curve adolescent idiopathic scoliosis underwent surgery from April 2002 to May 2005, among whom 66 were grouped as Lenke-type IA , 16 as Lenke-type IB and 14 as Lenke-type IC. 24 patients were treated with anterior spinal fusion and others with posterior fusion. The upper instrumented vertebrae evolved to be the upper neutral vertebrae. The lower neutral vertebrae or the vertebrae at 1 level proximal to the neutral vertebrae or stable vertebrae were chosen as the lower instrumented vertebrae based on the analysis to the correlation among the lower end vertebrae,neutral vertebrae and stale vertebrae's locations. Standing anteroposterior and lateral and side-bending radiographs were taken preoperative, standing anteroposterior and lateral radiographs were taken postoperative and at the follow-up. The coronal and sagittal Cobb angle,translation and rotation of apical vertebrae, trunk translation were evaluated to observe the curve correction and trunk balance. Patients underwent spinal fusion of average 7.3 segments(4～10segments) and with follow-up average 15.9 months(12～ 39months).Result: No serious complications as neural injury were found perioperatively. Thoracic curves' coronal Cobb angle were corrected from 54.9° ± 13.6° (40°-98°) to 17.6°±8.3°(3°-40°) .average correct rate: 68.6%±12%(54%～93%); lumbar curves' coronal Cobbangle were corrected from 32.4°±10.4° (25°—69°) to 10.7°±6° (0°—30°) .average correct rate: 66.7%±15%(44%—100%) . Trunk translation were corrected from 17.8±11.7mm(4～43mm) to 8.9±6.7mm (0～25mm). Three patient was found with slight trunk decompensation postoperative, but with no progression with a 2 years follow-up.Conclusion: Choose the method of surgery reasonably according the curve location and flexibility and determine the fusion levels based on the analysis to the correlation among the end vertebrae, neutral vertebrae and stale vertebrae's locations, we can obtain the satisfied curative effect in the management of single thoracic curve adolescent idiopathic scoliosis.