Spontaneous derotation of compensatory lumbar curve after thoracic fusion in adolescent idiopathic scoliosis

Introduction: Currently, excellent three-dimensional correction can be achieved with use of segmental pedicle screw fixation in adolescent idiopathic scoliosis (AIS). In the majority of patients with major thoracic curves, selective thoracic fusion (STF) may be considered to maximize motion segment of the unfused lumbar spine. This study aimed to investigate the extent of spontaneous derotation of the lumbar curve following STF. Methods: AIS patients who underwent STF using posterior pedicle screw fixation were retrospectively reviewed. Angle of vertebral rotation was defined as the difference between the axial rotation angles of the apical vertebra and S1 vertebra on axial CT images. Radiographic measurements included major thoracic curve, thoracolumbar/lumbar curve (preoperative and postoperative), and side-bending curve. The relationships between the axial rotation of the lumbar spine and radiographic measurements were also analyzed. Results: Thirty patients (all females) were included. Preoperative thoracic Cobb measured 62.1±9°, which improved to 20.3±5° at 2 years postoperatively, resulting in 67% correction. Preoperative lumbar Cobb measured 38.0±9°, which spontaneously improved to 19.0±7°, indicating a 50% correction. Preoperatively, the axial rotation of apical lumbar vertebra was 10.2±5.5°, which changed to 7.0±4.8° (32% spontaneous correction). Comparing the correction between the axial rotation of the lumbar spine and other parameters, postoperative angle of axial rotation correlated well with preoperative (r=0.79) and postoperative (r=0.82) lumbar Cobb angle. Meanwhile, the improvement of axial rotation of the lumbar spine correlated with postoperative thoracic curve (r=－0.42), postoperative lumbar curve (r=－0.57), and thoracic apical translation change (r=0.43). Conclusions: In AIS patients with major thoracic curves, spontaneous axial derotation of the lumbar curves occurred with a mean correction rate of 32% after STF. A greater spontaneous derotation of the lumbar curve would be related to correction of the thoracic curve.