Simultaneous Selective Thoracic Fusion of Lenke-1C Scoliosis and Reduction of Symptomatic Spondylolisthesis: A Case Report

Abstract

The combined treatment of unrelated Lenke-1C curves and spondylolisthesis represents a challenge: The two arthrodesis areas must achieve corrections while preserving mobility as much as possible. We reported a case of 20-year-old girl with Lenke-1C scoliosis and Meyerding grade-2 symptomatic L5-S1 isthmic spondylolisthesis. She was treated with one-stage correction with T3-T12 posterior selective thoracic fusion (STF) associated to reduction and fusion of the spondylolisthesis. Pre-op Cobb angle of the main thoracic (MT) curve was 62°. The non-structural lumbar (L) curve was 52°. Coronal imbalance was 39 mm. 1-month post-op X-ray showed a reduction of MT-curve to 32° and L-curve to 24°. The coronal imbalance was 13 mm. A satisfactory sagittal alignment and olisthesis reduction were achieved. At 24-months follow-up, L-curve increased to 30°. Coronal imbalance was 24 mm. Loss of correction appeared stable at 36-months final follow-up. Although the evidence cautiously suggests STF to treat also Lenke-1C scoliosis, this case confirmed that the risk of worsening coronal decompensation exists, and it is possibly increased by a distal lumbar arthrodesis to treat spondylolisthesis. However, we believe that STF is justified as worsening L-curve does not balance the possibility of preserving motility of the lumbar tract, also because the need for revision is an uncommon event.

Keywords

• lenke-1c scoliosis
• spondylolisthesis
• spine deformity
• selective thoracic vertebral arthrodesis