• Zhihui Zhao, Zhen Liu, Zongshan Hu, Changchun Tseng, Jie Li, Benlong Shi, Yong Qiu, and Zezhang Zhu.
• Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
• Spine. 2019 Feb 1; 44 (3): E168-E174.

Study DesignA retrospective study.ObjectiveThe aim of this study was to compare the long-term outcomes of correction surgery for Lenke 1 A/B scoliosis among those with symmetric fusion (SF), upper-dominant fusion (UF), and lower-dominant fusion (LF) in adolescent idiopathic scoliosis (AIS).Summary Of Background DataSymmetric fusion, defined as equal number of vertebral levels included in instrumented fusion above and below the apical vertebra or disc of the primary curve, was a new concept raised in AIS selective fusion. Previous study showed that similar correction the effect on clinical outcomes of this fusion style.MethodsPreoperative, postoperative, and last follow-up radiographs of 117 consecutive patients with Lenke type 1A/B curves who underwent posterior selective thoracic instrumentation surgery were analyzed. Patients were divided into two groups (SF and nonsymmetric fusion [NSF]). Patients in NSF was further divided into two groups UF (more vertebrate was fused above the apex) and LF (more vertebrate was fused below the apex). Clinical outcomes and coronal decompensation including adding-on and trunk shift were analyzed and compared among three groups.ResultsThere was no significant difference between SF and NSF in magnitude of preoperative main thoracic curve (P = 0.69) and correction rate (P = 0.50). Distal adding-on was observed in 21 patients (17.9%), and coronal decompensation was observed in eight patients (6.8%) in all at final follow up. No significant differences were found between the two groups regarding adding-on phenomenon (P = 0.64) and coronal imbalance (P = 0.72). Significantly higher rates of adding-on were found in UF compared with SF and LF (P < 0.001). In a subgroup analysis between UF and LF in NSF patients, significant differences were found between two subgroups in the rate of trunk shift (P = 0.038). No significant differences in SRS-22 scores were observed among the three groups.ConclusionIn Lenke 1A/B AIS with posterior selective fusion, SF provides no significant differences from NSF. However, in NSF, UF was found to be high risky of adding-on phenomenon.Level Of Evidence3.

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