ArticleJournal of orthopaedic surgery and research2026
Optimizing surgical strategy in Lenke 5 C AIS patients with poor thoracic compensatory ability: is there a role of coronal imbalance?
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo investigate the effect of preoperative coronal balance patterns on the clinical outcome of Lenke 5 C patients with poor thoracic curve compensation ability following different fusion strategies.
methodsPoor thoracic compensatory ability was defined as a thoracic cobb angle between 15° and 25° on supine bending films. Coronal balance patterns were classified as Type A (coronal balance distance (CBD)<20 mm), Type B (CBD > 20 mm and C7 plumbline (C7PL) shifted to concave side of main curve), and Type C (CBD > 20 mm and C7PL shifted to convex side of main curve), based on CBD and position of C7PL relative to main curve. Patients with preoperative Type C were classified into the Group Type C1(underwent selective fusion) and the Group Type C2(underwent non-selective fusion), and patients with preoperative Type A all underwent selective fusion surgery. Quality of life in preoperative Type C patients following different fusion strategies was assessed using the SRS-22 scale.
resultsPatients with preoperative Type C coronal pattern and poor thoracic compensatory ability showed a higher likelihood of thoracic curve progression after selective fusion surgery compared to Type A patients (48.7% vs. 20.9%, P = 0.007). In the Type A group, only 4.65% experienced thoracic curve progression exceeding 10°, while in the Type C1 group, this percentage was 21.95%. Additionally, at the last follow-up, 93.1% of Type A patients maintained good coronal balance, whereas 17.1% of Type C1 patients still had coronal imbalance. Type C2 patients who underwent non-selective fusion showed improved thoracic curvature from 34.86 ± 4.64° to 11.14 ± 4.30°, which was well maintained during follow-up. At the last follow-up, only 1 of 35 (2.8%) patients retained the Type C coronal pattern. The SRS-22 questionnaire showed that in Lenke 5 C AIS patients with preoperative Type C, the Type C2 group had significantly higher pain (4.33±0.51 vs. 3.87±0.55, P = 0.003) and self-image scores (4.88±0.10 vs. 4.55±0.50, P = 0.020) compared to the Type C1 group.
conclusionFor Lenke 5 C AIS patients exhibiting poor thoracic compensatory ability and preoperative Type C coronal imbalance, selective fusion demonstrated higher risks of proximal thoracic curve progression compared and inferior coronal balance restoration during follow-up. These findings suggest cautious consideration for preoperative coronal pattern and poor thoracic compensatory ability in Lenke 5 C AIS patients when planning surgery strategies.
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