Evaluation of long term outcome of selective fusion in patients with idiopathic scoliosis

Background: Instrumented fusion is the standard treatment in adolescent idiopathic scoliosis (AIS). In patients with both thoracic and lumbar curves there is a trend toward fusing the major curve and keeping the spine mobile with greater function in the future. To evaluate the results of selective fusion in patients with AIS, we aimed to do this research in eligible patients with adolescent idiopathic scoliosis referred to educational hospitals in Isfahan, Iran. Methods: This is a retrospective cross-sectional study which was performed in 2019 in educational hospitals in Isfahan. The study population consisted of 21 patients with idiopathic scoliosis who had been treated with the selective fusion method in 2010-2018. Demographic data of patients including age, sex, and previous medical history and operation results were noted from medical documents of all patients. Cobb's angle measurements and assessments related to complications, Patients' satisfaction and outcome of the surgery were assessed using Patient Outcome Questionnaires developed by Scoliosis Research Society (SRS-22) and 36-Item Short Form Survey (SF-36) questionnaires. Results: A total of 21 patients with idiopathic scoliosis were enrolled in the study. The lowest follow-up duration was 2 years and the longest duration was 10 years. We showed that the mean upper curve before interventions were 50.66 +/- 7.55 and the mean lower curve before interventions was 35.19 +/- 3.86. These amounts improved significantly after surgeries (P<0.001). Evaluation of thoracic apical vertebral translation (AVT) to thoracolumbar or lumbar AVT ratio also showed significant improvements (P<0.001). Conclusion: Patients undergoing selective fusion benefit from this surgical procedure. The upper and lower curves improved significantly and 85.8% of patients were satisfied with the surgery. Stopping fusion above the L2 in all patients left the lumbar spine mobile which is an important factor in patient satisfaction. We suggest that selective fusion be considered for surgical treatment of some patients with idiopathic scoliosis.