Controversy surrounds the question of determining when a selective thoracic fusion should be performed for adolescent idiopathic scoliosis with a Lenke Type 1C curve pattern. There is a risk for residual deformity when the lumbar curve is not fused, and multiple factors influence the final coronal alignment, including the coronal alignment prior to surgical treatment. In a paper from the Harms Study Group titled, “Is Decompensation Preoperatively a Risk in Lenke 1C Curves?“, the effect of coronal alignment prior to surgery on postoperative alignment was investigated. Decompensation was defined as a difference between the C7 and center sacral lines of greater than 2 centimeters. The authors found that decompensation to the left was common in this type of scoliosis, and that such decompensation did not always spontaneously correct after a selective thoracic fusion. This knowledge should be an important component of the preoperative planning and discussion. The research was published in the journal Spine.
Hillard T. Spencer, MD 