• Anuj Singla, James T Bennett, Paul D Sponseller, Joshua M Pahys, Michelle C Marks, Baron S Lonner, Peter O Newton, Firoz Miyanji, Randal R Betz, Patrick J Cahill, and Amer F Samdani.
• *University of Virginia Health System, Charlottesville, VA †Shriners Hospitals for Children, Philadelphia, PA ‡Johns Hopkins Hospital, Baltimore, MD §Rady Children's Hospital, San Diego, CA ¶NYU Hospital for Joint Diseases, New York, NY ‖British Columbia Children's Hospital, Vancouver, British Columbia, Canada; and **Institute for Spine & Scoliosis, Lawrenceville, NJ.
• Spine. 2014 Nov 15;39(24):2034-41.

Study DesignA retrospective analysis of a prospectively collected multicenter database.ObjectiveTo identify the radiographical and clinical outcomes in Lenke 3 curves fused selectively (S) versus nonselectively (NS).Summary Of Background DataSurgical treatment options for Lenke 3 curves include fusion of both curves (NS) or selective thoracic curve fusion (S). Selective fusion of the thoracic curve spares lumbar motion segments; however, it may result in marked residual deformity.MethodsA prospectively collected multicenter database was retrospectively reviewed for adolescent idiopathic scoliosis Lenke 3 curves treated with posterior spinal fusion with a minimum of 2 years of follow-up. Patients were divided into 2 groups: NS (nonselective fusion) and S (selective thoracic fusion). Radiographical and clinical data were compared between the groups using the unpaired Student t test and analysis of variance.ResultsA total of 74 patients met our inclusion criteria, with 49 (66.2%) in the NS group and 25 (33.8%) in the S group. Overall, both groups were similar preoperatively except for lumbar Cobb (NS = 56.3°, S = 47.2°, P < 0.001), lumbar lordosis (NS = 56.9°, S = 67.2°, P = 0.001), lumbar rotational prominence (NS = 11.2°, S = 8.2°, P < 0.05), and lumbar apical translation (NS = 3.2 cm, S = 1.9 cm, P < 0.05). Postoperatively, NS fusion demonstrated significantly less coronal imbalance of 2 cm or less (NS = 10.2%, S = 56.0%, P < 0.001), better lumbar curve correction (NS = 68.2%, S = 51.9%, P < 0.001), better lumbar apical translation correction (NS = 1.2 cm, S = 2.1 cm, P < 0.01), and better percent correction of the lumbar prominence (NS = 66.5%, S = 40.4%, P < 0.05). Scoliosis Research Society Questionnaire 22 scores at 2 years were similar between the groups.ConclusionDespite preoperatively smaller lumbar curves with less apical translation and lumbar prominence, most patients with selective fusions were out of balance postoperatively and had inferior radiographical outcomes as compared with their nonselective comparison cohort with similar patient-reported outcomes. Long-term follow-up is required to determine whether the trade-off of sparing motion segments at the expense of somewhat lessened radiographical outcomes is worthwhile.

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