Balancing radiographic correction with quality of life: a meta-analysis of selective versus non-selective thoracic fusion in Lenke 1 C AIS.

Abstract

The optimal surgical strategy for Lenke 1 C adolescent idiopathic scoliosis (AIS) remains debated. Selective thoracic fusion (STF) preserves lumbar mobility by limiting fusion to the thoracic curve, while non-selective thoracic fusion (NSTF) extends distally to address the thoracolumbar/lumbar (TL/L) curve. The comparative long-term impact of these strategies on health-related quality of life (HRQoL) remains uncertain. A systematic search was performed in PubMed, Scopus, Cochrane Library, and Google Scholar till September 2025. Five studies met the inclusion criteria. Key outcomes included perioperative outcomes (operative time and blood loss), radiographic parameters (state them with abbreviations), and HRQoL assessed with SRS-22r or SRS-30, pooled using a random-effects model. STF was associated with significantly shorter operative time (MD - 76.21 min, p < 0.001) and reduced blood loss (MD - 27.30 mL, p = 0.02). No difference was observed in MT Cobb angle correction at 2 years (p = 0.17). NSTF achieved superior TL/L outcomes, with a smaller residual Cobb angle (MD 5.14°, p = 0.04) and a higher correction rate (MD - 23.65%, p < 0.001). HRQoL analysis showed no significant differences between groups in any domain, including function/activity, pain, self-image/appearance, mental health, satisfaction with management, or in total score (all p > 0.05). STF reduces surgical burden and preserve lumbar motion, while NSTF achieves superior TL/L correction. Yet, these differences did not translate into significant HRQoL variation, suggesting that in borderline Lenke 1 C patients, surgical decision-making should not rely on radiographic outcomes alone but also integrate patient-centered and subjective considerations.