Anterior Dynamic Versus Posterior Transpedicular Spinal Fusion for Lenke Type 5 Idiopathic Scoliosis: A Comparison of Long-term Results

Abstract

Background. Despite the active implementation of dynamic correction in case of idiopathic scoliosis, there are no comparative studies of results of posterior and anterior dynamic correction in patients with completed and near-completed growth. Aim of the study to compare clinical and radiological results of anterior dynamic correction and conventional posterior transpedicular correction of Lenke type 5 scoliotic defonnities in patients with completed or near-completed growth. Methods. Eighty-six patients with Lenke type 5 scoliotic deformities were enrolled in the study. The first group (54 patients) underwent deformity correction via posterior approach using a rigid transpedicular system; the second group (32 patients) using dynamic correction system. Mean patients age was 22.612.8 and 27.310.9 years, respectively. We studied radiological data before surgery, immediately after surgery, and 2 or more years after surgery. Blood loss volume, duration of hospital stay, and duration of narcotic analgesics intake in the early postoperative period were analyzed. Functional results were assessed using SRS-22 questionnaire. Results. Preoperative Cobb angle in the first group was 65.5, and 27.5 at the long-term follow-up. Junctional kyphosis of T10-L2 before surgery was 21.0 and 13.2 at the long-term follow-up. Preoperative Cobb angle of the initial curve in the second group was 52.5 and 24.5 at the long-term follow-up. Junctional kyphosis of T10-L2 before surgery was 19.5, and 19.0 at the long-term follow-up. Nash and Moe apical vertebral rotation in the first group before surgery was 1.62 and 0.17 at the last follow-up; in the second group, it was 1.80 and 0.81, respectively. Mean number of fixed levels was 6.41.0 in the first group and 5.61.5 in the second group. Mobility of the thoracolumbar/lumbai curve was higher in the second group, 28.29.1, compared with 36.0 7.2 in the first group. Preoperatively, lumbar lordosis in the second group was 42.5, in the long-tenn period 43.5, and in the first group 43.4 and 44.3, respectively. Conclusion. Both posterior rigid and anterior dynamic correction in case of Lenke type 5 idiopathic scoliosis can provide satisfactory radiological results with initially similar thoracolumbar deformities in patients with completed or nearcompleted growth. However, dynamic approach can reduce blood loss, duration of hospital stay, duration of narcotic analgesics intake after surgery, and improve quality of life in the long-term period.

Keywords

• lumbar scoliosis
• spinal fusion
• lenke type 5
• anterior dynamic fusion
• transpedicular fusion