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. Methods: Patients with Lenke type 5C scoliosis who underwent selective (group 1) or nonselective (group 2) instrumentation were retrospectively analyzed. Group 1 included 47 patients (42 females and five males) with a mean age of 16.1 +/- 2.4 year (range, 12-22), and group 2 included 58 patients (53 females and five males) with a mean age of 16.3 +/- 3.4 yr (range, 12-24; P > .05). 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. Results: Both groups exhibited similar results in terms of coronal, sagittal, and spinopelvic balance as well as shoulder balance in many data after surgery (P > .05). Clinical outcomes, assessed via SF-36 mental health and SRS-22(r) scores, did not show statistically significant differences between groups (P > .05), except fort the physical role difficulty domain of the SF-36, where the selective fusion group (77.1 +/- 31.6) showed significantly better scores than nonselective group (58.2 +/- 36.1). 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.