# Advances in fusion level selection and surgical approaches for adolescent idiopathic scoliosis based on the Lenke classification system: a narrative review

## TL;DR

This review discusses recent developments in spinal fusion surgery for adolescent scoliosis using the Lenke classification system.

## Contribution

The paper summarizes updated surgical strategies for fusion levels in adolescent idiopathic scoliosis based on the Lenke classification.

## Key findings

- Fusion surgical guidelines based on the Lenke classification have been refined over the past decade.
- New strategies have emerged, but no revolutionary changes have occurred in the Lenke-based fusion approach.
- Controversies remain in surgical design selection for certain Lenke subtypes.

## Abstract

Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spinal deformity, frequently requiring fusion surgery. An optimal fusion surgical strategy can not only achieve effective correction but also reduce the incidence of postoperative complications. Recently, several researchers have refined and expanded AIS fusion surgical strategies based on the Lenke classification system, which is the current international standard for AIS. Therefore, this study aims to review the advances in fusion level selection and surgical approaches for AIS based on this classification.

Databases such as PubMed, Embase, Web of Science, Scopus, Cochrane Database, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Literature Database were queried for articles using the keywords “adolescent idiopathic scoliosis”, “fusion surgery”, “Lenke classification system”, “Lenke 1”, “Lenke 2”, “Lenke 3”, “Lenke 4”, “Lenke 5” and “Lenke 6”.

Over the past decade, fusion surgical guidelines based on the Lenke classification have been refined, with new strategies emerging. We summarize the latest AIS fusion surgical strategies with recent research results. However, the fusion strategy based on the Lenke classification system has undergone no revolutionary changes. The selection of surgical designs for certain subtypes remains controversial.

The fusion surgical strategy based on the Lenke classification system remains the standard for AIS surgical treatment. With the advancement of surgical technologies, further optimization of surgical strategies and the development of three-dimensional classification systems are potential future directions.

The online version contains supplementary material available at 10.1186/s12893-025-03481-9.