• Akira Matsumura, Masayoshi Iwamae, Takashi Namikawa, Minori Kato, Yusuke Hori, Noriaki Hidaka, Hiroaki Nakamura, and Hidetomi Terai.
• Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan. Electronic address: amatsumura@med.osaka-cu.ac.jp.
• World Neurosurg. 2021 Jul 1; 151: e241-e249.

ObjectiveTo evaluate prevalence and prognosis of postoperative coronal imbalance (CIB) and factors related to its onset and spontaneous improvement in patients with Lenke 5C adolescent idiopathic scoliosis who underwent selective thoracolumbar-lumbar fusion.MethodsWe measured radiographic parameters and evaluated clinical outcomes using the Scoliosis Research Society-22 questionnaire in patients with Lenke 5C adolescent idiopathic scoliosis and a minimum 2-year follow-up. CIB was defined as >2 cm distance between C7 plumb line and central sacral vertical line. We compared parameters between patients with CIB (CIB group) and without CIB (coronal balanced group).ResultsInclusion criteria were met by 29 patients (mean age at surgery:17.0 years; average follow-up period: 45.6 months). CIB was found in 10 patients 1 week after surgery (34.5%); this decreased to 6.9% at final follow-up. Comparative analysis indicated significant values as follows: age at surgery (17.5 years vs. 14.7 years, P = 0.005), lumbosacral curve (5.9° vs. 11.2°, P = 0.02), and L5 tilt (-3.6° vs. -8.1°, P = 0.02) in bending film. Greater changes of lowest instrumented vertebra disc angle, which means scoliotic angles between LIV and LIV+1, were significantly associated with spontaneous improvement of CIB (P = 0.04). Clinical outcomes were comparable between the coronal balanced and CIB groups.ConclusionsAlthough CIB was frequently detected in the early postoperative period after selective thoracolumbar-lumbar fusion, it mostly corrected spontaneously. Relatively younger age at surgery and less flexible lumbosacral curve may be related to postoperative CIB, and greater changes of LIV disc angle may be associated with spontaneous improvement of CIB.Copyright © 2021 Elsevier Inc. All rights reserved.

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