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. 2022 Sep;10(5):1107-1115.
doi: 10.1007/s43390-022-00512-w. Epub 2022 May 9.

Ten-year follow-up of Lenke 5 curves treated with spinal fusion

Nicholas D Fletcher  1 , Tracey P Bastrom  2 , Noelle A Larson  3 , Stefan Parent  4 , Baron A Lonner  5 , Burt Yaszay  6 , Michael P Kelly  2 , Mark A Erickson  7
Affiliations

Ten-year follow-up of Lenke 5 curves treated with spinal fusion

Nicholas D Fletcher et al. Spine Deform. 2022 Sep.

Abstract

Introduction: Patients with surgically treated Lenke 5 curves require at least partial fusion of the lumbar spine. The implications of lumbar fusion remain unknown as long-term follow-up is sparse.

Methods: A retrospective review of a prospectively collected registry of patients with Lenke 5 curves treated with spinal fusion was performed. Clinical and radiographic outcomes as well as SRS-22 scores were collected at 2- and 10-year follow-up.

Results: 54 of 247 available patients met all inclusion criteria [26 treated with posterior spinal fusion (PSF) and 28 with anterior spinal fusion (ASF)]. Preoperative lumbar curve magnitude was 45.1 ± 8.4° and corrected to 14.0 ± 7.2° (p < 0.001). A 3.3 ± 7.3° increase in curve size was noted at final follow-up (p < 0.008) with 20.3% of patients having a loss of correction (LOC)of 10° or more. Thoracic curve correction and kyphosis were stable at 10-year follow-up. End vertebrae angulation improved from 11.2 ± 23.2° to 0.96 ± 6.4° (p = 0.004) and translation improved from 2.5 ± 2.9 to 0.92 ± 1.5 cm (p = 0.008) with no LOC. Disc wedging below the lower instrumented vertebrae increased from 0.3 ± 4.9° to 2.8 ± 4.4° (p < 0.001) with no change at 10 years. SRS-22 self-image and satisfaction improved from post-operative to final follow-up. No patient required a second operation.

Conclusions: Both ASF and PSF showed durable results at 10-year follow-up with no obvious difference between approaches. 20% of patients had a LOC > 10°; this did not correlate with pain or need for revision surgery. Disc wedging was stable. Selection of LIV did not correlate with pain scores.

Level of evidence: Level III.

Keywords: Adolescent idiopathic scoliosis; Lenke 5; Spinal fusion; Thoracolumbar.

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