Research Fellow Banner University Hospital Phoenix, Arizona, United States
Introduction: Lenke 5 curves are challenging to manage surgically due to the risk of adding on, PJK and degenerative disc wedging in the lower lumbar vertebra which has been associated with chronic lumbar and worse outcomes. Selective fusion is considered a good option in lumbar curves because it preserves motion of the lumbar segments, yet nonselective fusion remains prevalent. This study aims to identify baseline patient characteristics that drive treatment and to compare postoperative outcomes for both procedures
Methods: Studies that compared baseline and postoperative demographic data, SRS-22 questionnaire, and radiographic parameters of patients with Lenke 5 curves undergoing selective fusion or standard treatment were identified for meta-analysis. The effect measure is expressed as Mean difference with 95% CI. A positive MD signifies a greater value for the nonselective group
Results: 6 retrospective case-control studies with sample size of 317 patients (217 in the selective fusion group and 110 in the non-selective group) were identified. Baseline age, sex, and HRQLs were equivalent. As expected there was a significant difference between groups regarding the fused levels MD -2.94 (-3.27, -2.6; p< 0.001) Pre op Lumbar curves were significantly worse in the non-selective group as measured by the thoracolumbar/lumbar (TL/L) Cobb angle MD: -3.43° (-5.54, -1.33; p < 0.001). Radiographic findings significantly improved in both groups. No difference was found between both groups in terms of lumbar correction or coronal balance (p0.61), but the thoracic curve improved more in the long term in the non-selective group MD 1.73° (0.06,3.41, p0.04). No differences were found regarding post op SRS 22 or surgical complications during the follow up (p0.21).
Conclusion : Patients with larger lumbar curves displaying larger degree of coronal translation, are more likely to undergo non selective treatment. Selective and non-selective groups have effective improvement in postoperative coronal balance, the non-selective group had better improvement in the compensatory thoracic curves. Due to absence in differences between both groups in terms of patients reported outcomes and post-operative coronal balance we recommend that the selective fusion should be the standard treatment for thoracolumbar/lumbar curves < 60° with nonstructural compensatory thoracic curves.
