Does curve convexity affect the surgical outcomes of thoracic adolescent idiopathic scoliosis?

Abstract

Background: Major left thoracic (LT) curve is an atypical type in adolescent idiopathic scoliosis (AIS) and showed independent clinical characteristics and natural history compared to major right thoracic (RT) curve. However, it's unclear whether the convexity of major thoracic curve would affect the surgical outcomes and risk of complications. A retrospective follow-up study was conducted to investigate whether the convexity of major thoracic curve would affect the surgical outcomes of patients with main thoracic AIS.

Methods: Twelve LT-AIS patients underwent corrective spinal instrumentation and fusion were retrieved, and twelve patients with main RT-AIS matched for gender, chronological age, curve type, magnitude and surgical strategy were selected as control. All patients underwent at least 2-year follow-up. The pre- and post-operative radiographic parameters, intraoperative data and functional outcome assessed by Scoliosis Research Society questionnaire 22 (SRS-22) were analyzed and compared between two groups.

Results: Patients with LT- and RT-AIS presented with similar magnitudes of thoracic curves, flexibility, fusion level and correction rate. Compared with RT-AIS, patients with LT-AIS showed longer operation time (average, 364 vs. 348 min) and larger amount intraoperative estimated blood loss (2,060 vs. 1,720 ml) although the differences were not statistically significant (p > 0.05). With at least 2-year follow-up, patients in two groups showed comparable loss of correction, coronal and sagittal balance, and the sagittal profiles. With regard to functional outcome, the scores of five categories of SRS-22 questionnaire were similar between two groups. No neurological or vascular complication was observed in these patients.

Conclusions: The radiographic and functional outcomes of LT-AIS patients underwent operation were comparable to those with RT-AIS. Longer operation time and more intraoperative blood loss may be expected in instrumentation and fusion for patients with LT-AIS, which might be because of the inconvenience on the surgical procedure.