• Jacob Schulz, Jahangir Asghar, Tracey Bastrom, Harry Shufflebarger, Peter O Newton, Peter Sturm, Randal R Betz, Amer F Samdani, Burt Yaszay, and Harms Study Group.
• *Department of Orthopedics, Montefiore Medical Center, Bronx, NY †Department of Orthopedics, Miami Children's Hospital, Miami, FL ‡Department of Orthopedics, Rady Children's Hospital, San Diego, CA §Department of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH ¶Institute for Spine and Scoliosis, Lawrenceville, NJ ∥Shriners Hospital for Children, Philadelphia, PA; and **Setting Scoliosis Straight Foundation, San Diego, CA.
• Spine. 2014 Nov 1;39(23):E1368-73.

Study DesignRetrospective review of prospective data.ObjectiveTo define optimal postoperative coronal parameters after selective thoracic fusions (STFs) and to test these parameters against recommended criteria for when to perform an STF.Summary Of Background DataPrevious studies have provided recommendations for when STF should be performed; however, clear parameters for target outcomes are lacking.MethodsPatients with Lenke 1C to 4C curves with adolescent idiopathic scoliosis from a multicenter database who underwent STF with minimum 2 years of follow-up were included. Postoperative parameters included lumbar Cobb angle, trunk shift, coronal balance, percent lumbar correction, and deformity-flexibility quotient. First, the upper 95% confidence interval for each parameter was calculated (queried data threshold) and set as the limit of "optimal" outcomes. Second, an independent surgeon survey was performed, and in patients with unanimous surgeon agreement of "success," the upper 95% confidence interval was determined (surgeon-derived threshold). Scoliosis Research Society-22 scores were compared between those above and below these 2 thresholds. Then, these outcomes were used to determine whether adherence to, or disregard for, previously published guidelines for STF were predictive of final outcome.ResultsA total of 106 patients were analyzed. Target postoperative parameters as determined by the queried data and surgeon-derived thresholds were similar and rounded to: deformity-flexibility quotient less than 4, lumbar Cobb angle less than 26°, lumbar correction more than 37%, coronal balance 2 cm or less, and trunk shift less than 1.5 cm. Patients within target parameters had significantly better Scoliosis Research Society-22 satisfaction scores. Neither preoperative apical vertebral translation ratio more than 1.2 nor Cobb angle ratio more than 1.2 predicted 2-year success. Preoperative lumbar curve less than 45° and lumbar bend less than 25° were associated with increased likelihood of optimal outcomes.ConclusionOptimal postoperative outcomes for STF should include a lumbar Cobb angle less than 26°, coronal balance 2 cm or less, deformity-flexibility quotient less than 4, lumbar correction more than 37%, and trunk shift less than 1.5 cm. These findings suggest that performing an STF in patients with a preoperative lumbar Cobb angle less than 45° or a preoperative lumbar bend less than 25° will increase one's chances of success.Level Of Evidence4.

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