Spinal balance and lumbar curve stability after selective thoracic fusion in idiopathic scoliosis

Aaron Gebrelul, Ann Marie Karam, Kiley Poppino, Chan Hee Jo, Benjamin S Richards

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: Selective thoracic fusion (STF) for double curve patterns in idiopathic scoliosis is an attractive treatment option. However, short-term coronal decompensation and truncal imbalance are known findings. Previous studies with hook constructs showed that eventually balance is achieved via an increase in lumbar curve magnitude, as the lumbosacral obliquity did not change following surgery. Our aim is to investigate patients with idiopathic curves who underwent STF using all-pedicle screw constructs to determine if the uninstrumented lumbar curve and lumbosacral obliquity responded in the same manner as was previously reported with all-hook constructs. Methods: 102 consecutive patients with Lenke 1B, 1C or 3C curves who underwent STF using all-screw constructs at a single institution were included in this study. Radiographic assessment was performed, and patient reported outcomes were obtained. Subgroup analyses were performed based on preoperative thoracic: lumbar curve ratio as well as lumbar curve magnitude. Results: Overall, the patients showed statistically significant improvement in both trunk shift and L4-pelvis obliquity at final follow-up. The uninstrumented lumbar curves trended toward improvement over time, but did not reach statistical significance (p = 0.107). SRS-30 scores were statistically significantly improved in multiple domains. Conclusion: Selective thoracic fusion is an excellent treatment option in most double curve patterns. Balance in the coronal plane is predictably achieved at 2-year follow-up. The lumbosacral obliquity improves more with screw technology than was previously found with hook constructs; therefore, the improvement in balance over time does not depend upon an increase in the uninstrumented lumbar curve. Level of evidence: IV.

Original languageEnglish (US)
Pages (from-to)471-480
Number of pages10
JournalSpine deformity
Issue number2
StatePublished - Mar 2021


  • Balance
  • Pedicle screws
  • Selective thoracic fusion

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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