Comparison of Clinical and Radiologic Outcome of Three-Dimensional Correction in Lenke 5C Curve: Uniplanar Versus Polyaxial Pedicle Screws.

Abstract

To evaluate radiologic and clinical outcome of three-dimensional correction using the uniplanar pedicle screw (UPS) combined with vertebral body derotation technique for treatment of Lenke 5C adolescent idiopathic scoliosis. Fifty patients treated with posterior selective fusion by UPS or polyaxial pedicle screw (PPS) were enrolled. Radiologic parameters, including degree of main curve, thoracic kyphosis, lumbar lordosis, and apical vertebral rotation, were evaluated preoperatively, postoperatively, and at a minimum 2-year follow-up. Scoliosis Research Society Version 22 questionnaire was assessed preoperatively and at 2-year follow-up. Preoperative lumbar Cobb angle was 48.9° in the UPS group and 49.1° in the PPS group (P = 0.59). Postoperatively, no difference in the correction of the main curve magnitude between the 2 groups was observed (74.4% vs. 73.9%, P = 0.74). Correction rate of apical vertebral rotation in the UPS group was significantly higher compared with the PPS group. No difference in average thoracic kyphosis and lumbar lordosis was observed between the 2 groups. At last follow-up, Scoliosis Research Society Version 22 scores were improved in both groups, of which the self-image score in the UPS group was significantly higher compared with the PPS group. The application of UPS combined with vertebral body derotation technique can reduce vertebral rotation and obtain better patient self-image score when favorable coronal and sagittal realignment is achieved. This improvement remains superior during 2-year follow-up. This combined application is a promising option to achieve spinal three-dimensional correction in treating Lenke 5C curve.