Abstract
Background:
Adolescent idiopathic scoliosis (AIS) often mandates surgical management, with posterior fusion and pedicle screw constructs being the standard approach. Lenke 1B curve patterns have seen success with selective thoracic fusion, preserving lumbar function and avoiding a longer fusion construct. Our high-definition operative video details key steps of successfully performing a selective thoracic fusion for the correction of a Lenke 1B curve.
Case description:
Preoperative imaging was significant for right coronal offset, a 62° main thoracic curve, as well as thoracic hypokyphosis. T3-L1 posterior instrumented fusion with multiple posterior column osteotomies was performed. Considerations including skeletal maturity and alternative treatment options are discussed. Rationale of key maneuvers such as performing inferior articular dissection before pedicle screw placement, mitigation of spinal canal injury during concave pedicle screw placement, and differential rod contouring are all thoroughly highlighted.
Conclusion:
Selective thoracic fusion for Lenke 1B AIS can achieve robust coronal correction while preserving lumbar mobility. This surgical video highlights the critical technical nuances for this technique as well as patient-specific considerations that inform surgical decision-making and execution in this patient population.
Keywords: Adolescent Idiopathic Scoliosis, Lenke 1B, Posterior Spinal Fusion, Selective Thoracic Fusion, Surgical Video
[Video 1]-Available on:
0:07 - Clinical presentation
2:09 - Key surgical steps overview
2:47 - Surgical video
9:48 - Background and discussion.
Footnotes
How to cite this article: Faraj D, Fowler HF, Galgano M. Surgical video – technical nuances of performing a selective thoracic fusion for a Lenke 1B adolescent scoliotic curve. Surg Neurol Int. 2026;17:165. doi: 10.25259/SNI_195_2026
Contributor Information
Daniel Faraj, Email: dfaraj@ad.unc.edu.
Henry Forbes Fowler, Email: forbes_fowler@med.unc.edu.
Michael Galgano, Email: mgalgano@email.unc.edu.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship:
Nil.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of Artificial Intelligence (AI)-Assisted Technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Video available on:
Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
REFERENCES
- 1.Boniello AJ, Hasan S, Yang S, Jalai CM, Worley N, Passias PG. Selective versus nonselective thoracic fusion in Lenke 1C curves: A meta-analysis of baseline characteristics and postoperative outcomes. J Neurosurg Spine. 2015;23:721–30. doi: 10.3171/2015.1.SPINE141020. [DOI] [PubMed] [Google Scholar]
- 2.Miyaoka Y, Uehara M, Banno T, Seki S, Ohba T, Oba H, et al. Selective versus non-selective thoracic fusion for adolescent idiopathic scoliosis Lenke 1B/1C curves: Multi-center clinical and radiographic analysis at 2-year follow-up. Medicina (Kaunas) 2025;61:909. doi: 10.3390/medicina61050909. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.