Comparison of Radiologic and Clinical Results of Short-Long Level Posterior Fusion in Lenke Type 5C Scoliosis

Background: Lenke type 5C scoliosis is treated surgically with long-segment (nonselective) or short-segment (selective) level fusion. For Lenke type 5C scoliosis, no standardized criteria exist for selecting proximal and distal fusion levels. Studies report that short-segment level fusion patients with correct patient selection have a direct effect on the result of a well-balanced spine. Purpose: To compare the midterm and long-term radiologic and clinical outcomes of short-segment (selective) vs long-segment (nonselective) fusion in Lenke type 5C scoliosis. Design: Retrospective cohort study. Patient sample: This retrospective study evaluated patients who underwent posterior instrumentation for Lenke type 5C adolescent idiopathic scoliosis (AIS) at our institution between 2005 and 2016. Outcome measure: Physiologic measures: radiological evaluations included coronal, sagittal, and spinopelvic balance assessments as well as shoulder balance parameters on X-ray. Functional measures: clinical evaluations were performed using the SF-36 and SRS-22(r) scores. Radiological evaluations included coronal, sagittal, and spinopelvic balance assessments, as well as shoulder balance parameters. Clinical evaluations were performed using SF-36 and SRS-22(r) scores; results were compared between the two groups. However, the mean surgical time and transfusion requirement were significantly lower in the selective fusion group. Conclusion: When appropriately applied, selective fusion achieves comparable radiologic and clinical outcomes to nonselective fusion, with the added advantages of shorter surgical time and lower transfusion requirements. Key Concepts: (1)Selective fusion, when performed in appropriately selected patients, was found to be as stable as nonselective fusion in terms of shoulder balance, coronal balance, sagittal balance, and spinopelvic parameters.(2)Selective fusion offers several advantages, including shorter operative time, reduced blood loss, shorter hospital stays, and lower patient-based costs.(3)Lenke type 5 selective fusion has high stability within the right patient selection. Level of Evidence: Level III Case-control study or retrospective cohort study.