Comparative analysis of the clinical efficacies of three surgical methods for the treatment of Lenke type 5 adolescent idiopathic scoliosis

English Keywords:Adolescent idiopathic scoliosis  Lenke 5  Posterior intervertebral space release  Osteotomy

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacies of Scoliosis Research Society(SRS) level Ⅰ, level Ⅱ osteotomy and level Ⅱ osteotomy combined with intervertebral space release for the correction of Lenke 5 adolescent idiopathic scoliosis(AIS). Methods: A retrospective analysis was conducted on the clinical data of 101 Lenke 5 AIS patients who underwent surgical treatment in our hospital from January 2016 to September 2022 and had a follow-up period of over 2 years. There were 30 male and 71 female patients, aged 10-18 years(15.1±2.1 years). The patients were divided into three groups based on the surgical methods: group A of 37 patients underwent SRS Ⅰ level osteotomy, group B of 33 patients underwent SRS Ⅱ level osteotomy, and group C of 31 patients underwent SRS Ⅱ level osteotomy combined with intervertebral disc space release. There was no statistically significant difference in age, gender, body mass index(BMI), Risser sign, and other general data between the three groups(P>0.05). The patients were followed up for 24-43 months(30.3±4.1 months). The operative time, estimated intraoperative blood loss, number of fused segments, complications, and postoperative hospital stay were compared between the three groups. The thoracolumbar/lumbar(TL/L) scoliosis Cobb angle, apical vertebral translation(AVT), lumbar lordosis(LL), and thoracic kyphosis(TK) were measured on standing full-spine anteroposterior and lateral X-rays before surgery, one month after surgery, and at final follow-up. The preoperative apical vertebral rotation was assessed using the Nash-Moe grading system, and the postoperative apical vertebral derotation effect was evaluated according to the Upasani X-ray vertebral rotation grading criteria at 1 month after operation and final follow-up. The Scoliosis Research Society-22 questionnaire(SRS-22) was filled out by the patients before surgery and at the final follow-up to evaluate the clinical outcomes. Results: In terms of surgical-related indicators, group C had longer operative time compared with groups A and B(P<0.001), and no statistically significant differences were observed in estimated intraoperative blood loss, fusion segments, or hospital stay(P>0.05). Before surgery, there were no statistically significant differences in the Cobb angle of scoliosis, AVT, LL, and TK between the three groups(all P>0.05). The correction rates of the TL/L Cobb angle for the three groups after surgery were (72.66±6.24)%, (73.16±5.49)%, and (76.99±4.30)%, respectively. Group C had a higher correction rate than groups A and B, with statistical significance(P<0.05), while there was no significant difference between groups A and B(P>0.05). For preoperative apical vertebral rotation graded as Nash-Moe grade Ⅱ or lower, there were no statistically significant differences in correction rates between the three groups(P>0.05). For those graded greater than Nash-Moe grade Ⅱ, the correction rates for groups A, B, and C were (68.16±7.23)%, (68.69±4.70)%, and (76.64±5.75)%, respectively. Group C had a higher correction rate than groups A and B(P<0.001). The differences in postoperative and final follow-up apical vertebral rotation grades among the three groups were statistically significant(P<0.05), with group C achieving a more significant derotation effect compared with groups A and B(P<0.05). At final follow-up, the self-image domain scores of the SRS-22 questionnaire for all three groups were significantly improved compared with preoperative scores(P<0.05), and group C showed a more significant improvement than groups A and B(P<0.05). Conclusions: Compared with SRS level Ⅰ and Ⅱ osteotomies, the combination of SRS level Ⅱ osteotomy and posterior intervertebral space release can significantly improve the correction rate of TL/L scoliosis and the derotation effect of the apical vertebra in patients with Lenke 5 AIS.