Selective Thoracic Fusion of Lenke I and II Curves Affects Sagittal Profiles But Not Sagittal or Spinopelvic Alignment A Case-Control Study

Study Design. Literature review and retrospective case-control study (level 3 evidence) examining 50 adolescent idiopathic scoliosis (AIS) (Lenke I or II curve) cases with 32 healthy controls of the same age. The sagittal profiles were measured preoperatively, 6 months, and 2 years after surgery and compared with those of age-matched controls at baseline. Objective. The purpose of this study is to compare baseline sagittal profiles of AIS Lenke I and II curves with age-matched healthy controls and at 6 months and 2 years after surgery, as well as with previously published reports. Summary of Background Data. Sagittal alignment and profiles have gained significant attention in spinal deformity outcomes. The sagittal profi le of patients with AIS has been previously reported, as well as the effects of surgical correction, with inconsistent results and no clear references to nonscoliotic controls. Methods. Baseline sagittal profiles of 50 patients presenting with Lenke I or II AIS curves treated with selective thoracic fusion were compared with 32 age-matched controls without spinal pathology. These values were also measured at 6 months and 2 years postoperatively to examine effects of selective thoracic fusion over time. Sagittal parameters examined include pelvic incidence, pelvic tilt, C7 plumb line (sagittal vertical alignment), thoracic kyphosis, and lumbar lordosis. A literature review was performed comparing previously published data. Data are presented as mean (95% confidence interval). P value of less than 0.05 was considered significant. Results. Interobserver reliability (Cohen kappa = 0.49-0.95). All demographic and preoperative sagittal alignment parameters were comparable between controls and patients with AIS prior to surgery. After selective thoracic fusion, thoracic kyphosis decreased significantly from baseline (25.4 degrees [21.6-29.2] vs. 15.3 degrees [12.8-17.8]; P < 0.001) at 6 months and at 2 years (10.3 degrees [7.5-13.1]; P < 0.001). The lumbar lordosis significantly decreased at 6 months from baseline (54.5 degrees [28.6-80.5] vs. 61.8 degrees (33.4-90.1); P < 0.001) and at 2 years (55.4 degrees [29.0-81.9]; P < 0.001). Sagittal vertical alignment, pelvic tilt, and pelvic incidence were comparable between controls and patients with AIS at baseline and did not change with surgery. Conclusions. Adolescents with Lenke I or II curves have comparable sagittal profiles with those of healthy controls of the same age. This suggests that Lenke I and II curves may not be hypokyphotic as previously thought. After selective thoracic fusion, patients with AIS have a significantly decreased thoracic kyphosis, which is accompanied by reciprocal changes in the noninstrumented lumbar curve. Sagittal vertical alignment and pelvic tilt are not significantly affected. These results agree with previous reports, which suggest that constructs with pedicle screws have a higher impact on sagittal curves but do not affect sagittal or spinopelvic alignment. The long-term effects of abnormal sagittal profiles need further clarification.