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Guan-Din Method: A Novel Surgical Technique for Selective Thoracic Fusion to Maximize the Rate of Selective Thoracic Fusion and Compensatory Correction

Chang, Kao-Wha MD, PhD*,†; Chen, Yin-Yu MD*; Leng, Xiangyang MD; Wu, Chi-Ming MD*; Chen, Tsung-Chein MD*; Wang, Yu-Fei MD; Zhang, Guo-Zhi MD

doi: 10.1097/BRS.0000000000000111
Surgery
SLIDE

Study Design. Retrospective radiographical review.

Objective. To evaluate the outcome of selective thoracic fusion (STF) by using the Guan-Din method for the treatment of major thoracic compensatory lumbar (MTCL) curves.

Summary of Background Data. Performing STF for MTCL curves is to minimize the loss of lumbar motion and the risk of lumbar degeneration or pain. Surgical treatment of MTCL curves aims to maximize the rate of STF for MTCL curves while optimizing instrumental thoracic and compensatory lumbar correction. The Guan-Din method has been demonstrated to be able to enhance the lumbar curve's capacity for spontaneous correction and broaden the current curve criteria of MTCL curves for STF.

Methods. Between 2004 and 2010, 510 consecutive surgically treated MTCL curves were reviewed. Of these MTCL curves, who met the criteria of lumbar side bending Cobb 35° or less and without global thoracic hyperkyphosis and/or thoracolumbar kyphosis (T10–L2 ≤20°), were treated with STF using the Guan-Din method. Radiographs were analyzed before surgery, immediately after surgery, and at the most recent follow-up (range, 2–8 yr).

Results. Curve types of 510 MTCL curves according to Lenke system were as follows: 1A (n = 91), 2A (n = 74), 3A (n = 6), 4A (n = 2), 1B (n = 93), 2B (n = 34), 3B (n = 8), 4B (n = 5), 1C (n = 84), 2C (n = 26), 3C (n = 72), and 4C (n = 15). Of the 510 MTCL curves, 458 (90%) curves were treated with STF. A mean 73% thoracic correction and 63% lumbar correction was obtained at the most recent follow-up. Of the 197 surgically treated MTCL curves with a lumbar C modifier, 148 (75%) curves that contained 57 Lenke 1C and 2C curves and 40 Lenke 3C and 4C curves that did not meet Lenke curve criteria for STF, were successfully treated with STF. A mean 67% thoracic correction and 57% lumbar correction was obtained at the most recent follow-up. The rate of STF and the magnitude of correction of MTCL curves in this study were significantly greater than those in all other reports. No significant change in global coronal and sagittal imbalance was observed.

Conclusion. The rate of STF and the compensatory correction of MTCL curves could be maximized by using the Guan-Din method as the method for STF.

Level of Evidence: 4

Guan-Din method for selective thoracic fusion (STF) can enhance the lumbar curve's capacity for spontaneous correction and broaden the current curve criteria for STF. The rate of STF and magnitude of correction for major thoracic compensatory lumbar (MTCL) curves in this study were significantly greater than those in all other reports. Surgical treatment of MTCL curves aims to maximize the number of MTCL curves to be treated with STF while optimizing instrumented thoracic and spontaneous lumbar correction. The goal can be achieved by using Guan-Din method as the method for STF.

*Taiwan Spine Center, Jen-Ai Hospital, Taichung, Taiwan, Republic of China

The Second People's Hospital of Yunnan Province, Kunming, People's Republic of China; and

Affiliated Hospital to Changchun University of Traditional Chinese medicine, Changchun, Jilin, People's Republic of China.

Address correspondence and reprint requests to Kao-Wha Chang, MD, PhD, Taiwan Spine Center, Jen-Ai Hospital, 483 Dong Rong Rd, Tali, Taichung, Taiwan, Republic of China; E-mail: admin_c@taiwanspinecenter.com.tw

Acknowledgment date: May 14, 2013. First revision date: September 10, 2013. Second revision date: October 24, 2013. Acceptance date: October 25, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins