Motion preservation and deformity correction in Lenke 1 C adolescent idiopathic scoliosis: selective versus non-selective thoracic fusion.
Selective fusion preserves more lumbar motion segments than non-selective fusion in Lenke 1C scoliosis.
Motion preservation and deformity correction in Lenke 1 C adolescent idiopathic scoliosis: selective versus non-selective thoracic fusion.
The central surgical question in Lenke 1C adolescent idiopathic scoliosis (adolescent idiopathic scoliosis) is whether to extend fixation to include the compensatory thoracolumbar/lumbar (TL/L) curve (nonselective thoracic fusion, NSTF) or to limit instrumentation to the thoracic spine and rely on spontaneous lumbar correction (selective thoracic fusion, STF).
A PRISMA-compliant systematic review and meta-analysis were conducted (search: January 2025, updated April 2025; PubMed, Scopus, Web of Science; no language restriction).
selective fusion keeps nearly 3 more lumbar segments mobile
NSTF was associated with greater postoperative TL/L radiographic correction (primary pool: MD + 7.8°; 95% CI 2.12-13.41°; I 2 = 79.9%; p = 0.006; k = 2), with directional stability confirmed across all contributing studies in sensitivity analysis (k = 3: MD + 7.1°; 95% CI 4.08-10.03°; I 2 = 59.9%).
Coronal decompensation rates were not significantly different (OR: 1.60; 95% CI 0.82-3.12; I 2 = 6.3%; p = 0.17; k = 3).
Pooled SRS domain analysis did not demonstrate a consistent difference between procedures for any domain; all pooled MDs fell below the MCID of 0.2 points (k = 3 per domain).
Across ten studies evaluated within an outcome-specific eligibility framework, NSTF achieves greater TL/L radiographic correction in Lenke 1C adolescent idiopathic scoliosis, while STF preserves a clinically meaningful number of lumbar motion segments.
Available evidence did not demonstrate a consistent patient-reported outcome advantage for either procedure, though extreme heterogeneity substantially limits the interpretive value of pooled estimates.