• Chang Ju Hwang, Choon Sung Lee, Hyojune Kim, Dong-Ho Lee, and Jae Hwan Cho.
• Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
• Spine J. 2018 Oct 1; 18 (10): 1822-1828.

Background ContextCoronal imbalance is a complication of corrective surgeries in adolescent idiopathic scoliosis (AIS). However, few studies about immediate coronal decompensation in Lenke-5C curves have reported its incidence, prognosis, and related factors.PurposeTo evaluate the development of coronal imbalance after selective thoracolumbar-lumbar (TL/L) fusion (SLF) in Lenke-5C AIS, and to reveal related factors.Study DesignRetrospective comparative study.Patient SampleThis study included 50 consecutive patients with Lenke-5C AIS who underwent SLF at a single center.Outcome MeasuresWhole-spine anteroposterior and lateral radiographs were used to measure radiological parameters.MethodsPatients were divided into two groups according to the presence or absence of coronal imbalance (distance between C7 plumb line and central sacral vertical line >2 cm) in the early (1 month) postoperative period. Various radiological parameters were statistically compared between groups.ResultsOf the patients, 28% (14 of 50) showed coronal imbalance in the early postoperative period; however, most of them (13 of 14) showed spontaneous correction during follow-up. The development of coronal imbalance was related to less flexibility of the TL/L curve (51.3% vs. 52.6%, p=.040), greater T10-L2 kyphosis (11.7° vs. 6.4°, p=.034), and greater distal junctional angle (6.0° vs. 3.7°, p=.025) in preoperative radiographs. Lowermost instrumented vertebra (LIV) tilt was greater in the decompensation [+] group in the early postoperative period (8.8° vs. 4.4°, p=.009). However, this difference disappeared in final follow-up with the decrease of LIV tilt in the decompensation [+] group.ConclusionsLess flexibility of the TL/L curve, greater TL kyphosis, and greater distal junctional angle preoperatively were predictive factors for immediate coronal imbalance in Lenke-5C curves. Although coronal imbalance was frequently detected in the early postoperative period after SLF, it was mostly corrected spontaneously with a decrease of LIV tilt. Thus, SLF for Lenke-5C curves can be a good option regardless of the possible coronal imbalance in the early postoperative period.Copyright © 2018 Elsevier Inc. All rights reserved.

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