Transient fixation of L4 vertebra preserves lumbar motion and function in Lenke Type 5C and 6C scoliosis

• Published in: Scientific reports Vol. 11; no. 1; p. 10192
• Main Authors: Yang, Jae-Ho, Shin, Jae-Won, Park, Sub-Ri, Kim, Sun-Kyu, Park, Sang-Jun, Min, Ji-Hwan, Lee, Byoung-Ho, Suk, Kyung-Soo, Park, Jin-Oh, Moon, Seong-Hwan, Lee, Hwan-Mo, Kim, Hak-Sun
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 13.05.2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308/409; 692/698/1671; 692/699; Humanities and Social Sciences; Intervertebral discs; multidisciplinary; Science; Science (multidisciplinary); Scoliosis; Surgery; Vertebrae
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-89674-7

This study investigated the efficacy of a novel surgical method that relies on the transient fixation of L4 in Lenke Type 5C and 6C adolescent idiopathic scoliosis. Thirty-six transient surgically treated L4 fixation patients were retrospectively evaluated. The first surgery involved mechanical correction of scoliosis; the lowest instrumented vertebra (LIV) was L4. After an average of 1.3 years (range, 0.3–3.4), the second surgery to remove transient L4 pedicle screws was performed. Radiographic parameters and SRS-22 scores were measured. Cobb’s angle, coronal balance, LIV tilting angle, and LIV coronal disc angle clearly improved after the first surgery (p < 0.01). After the second surgery, the corrected Cobb angle (p = 0.446) and coronal balance were maintained (p = 0.271). Although L3/S1 lumbar lordosis decreased after the first surgery (p < 0.01), after removal of transient L4 pedicle screws, it recovered slightly (p = 0.03). Similarly, the preoperative L3/4 lateral disc mobility eventually recovered after transient L4 screw removal (p < 0.01). The function domain of the SRS-22 showed better scores after removal of transient L4 screws (p = 0.04). L4 transient fixation surgery is beneficial for Lenke Type 5C and 6C scolioses that do not fully satisfy LIV (L3) criteria. It preserves L3/4 disc motion, increases functional outcomes, and maintains spinal correction and coronal balance.