Effectiveness of short fusion versus long fusion for degenerative scoliosis with a Cobb angle of 20-40° combined with spinal stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yuanqiang ,  OU Yunsheng , ZHU Yong , ZHAO Zenghui , LUO Wei , XU Shuai , YU Haoyang

Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding?author：

OU Yunsheng, Email: ouyunsheng2001@163.com

Keywords：

Degenerative scoliosis; posterior decompression; long fusion; short fusion; spino-plevic parameters

DOI：

10.7507/1002-1892.201905105

Video：

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Objective To compare the effectiveness of decompression and short fusion or long fusion for degenerative scoliosis (DS) with a Cobb angle of 20-40° combined with spinal stenosis.Methods The clinical data of 50 patients with DS who were treated with decompression combined with short fusion or long fusion between January 2015 and May 2017 were retrospectively analysed. Patients were divided into long fusion group (fixed segments>3, 23 cases) and short fusion group (fixed segments≤3, 27 cases). There was no significant difference in gender, age, disease duration, and preoperative visual analogue scale (VAS) score of leg pain, Oswestry disability index (ODI), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), pelvic incidence (PI), pelvic title (PT), and sacral slope (SS) between the two groups (P>0.05); however, the VAS score of low back pain, Cobb angle, and sagittal vertical axis (SVA) in long fusion group were significantly higher than those in short fusion group (P<0.05), and the lumbar lordosis (LL) was significantly lower than that in short fusion group (t=2.427, P=0.019). The operation time, intraoperative blood loss, fluoroscopy times, hospital stay, and complications were recorded and compared. The VAS scores of low back pain and leg pain and ODI score were used to evaluate the clinical outcomes before operation and at last follow-up. X-ray films of the whole spine in standard standing position were taken before operation, at 6 months after operation, and at last follow-up, and the spino-pelvic parameters were measured.Results The operation time, intraoperative blood loss, and fluoroscopy times in the short fusion group were significantly less than those in the long fusion group (P<0.05); there was no significant difference in hospital stay between the two groups (t=0.933, P=0.355). The patients were followed up 12-46 months with an average of 22.3 months. At last follow-up, the VAS scores of low back pain and leg pain and ODI score significantly improved when compared with those before operation (P<0.05). Except for the improvement of VAS score of low back pain (t=8.332, P=0.000), the differences of the improvements of the other scores between the two groups were not significant (P>0.05). The Cobb angle, SVA, TLK, and PT significantly decreased, while SS and LL significantly increased in the long fusion group (P<0.05), while the Cobb angle and PT significantly decreased and SS significantly increased in the short fusion group at last follow-up (P<0.05). There was no significant difference in spino-pelvic parameters between the two groups at 6 months after operation and at last follow-up (P>0.05). The improvements of Cobb angle, SVA, LL, PT, and SS in the long fusion group were significantly higher than those in the short fusion group at last follow-up (P<0.05). There was no perioperative death in both groups. The incidence of complications in the long fusion group was 34.8% (8/23), which was significantly higher than that in the short fusion group [11.1% (3/27)] (χ²=4.056, P=0.034).Conclusion The DS patients with the Cobb angle of 20-40°can achieve satisfactory clinical outcomes and improve the spino-pelvic parameters by choosing appropriate fixation levels. Short fusion has less surgical trauma and fewer complications, whereas long fusion has more advantages in enhancing spino-pelvic parameters and relieving low back pain.

Citation： LI Yuanqiang, OU Yunsheng, ZHU Yong, ZHAO Zenghui, LUO Wei, XU Shuai, YU Haoyang. Effectiveness of short fusion versus long fusion for degenerative scoliosis with a Cobb angle of 20-40° combined with spinal stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 285-293. doi: 10.7507/1002-1892.201905105 Copy

1.	York PJ, Kim HJ. Degenerative scoliosis. Curr Rev Musculoskelet Med, 2017, 10(4): 547-558.
2.	Dohzono S, Toyoda H, Hori Y, et al. Spinopelvic sagittal alignment after microendoscopic laminotomy in patients with lumbar degenerative spondylolisthesis. J Neurol Surg A Cent Eur Neurosurg, 2018, 79(6): 479-485.
3.	Phan K, Xu J, Maharaj MM, et al. Outcomes of short fusion versus long fusion for adult degenerative scoliosis: A systematic review and Meta-analysis. Orthop Surg, 2017, 9(4): 342-349.
4.	Lee CH, Chung CK, Sohn MJ, et al. Short limited fusion versus long fusion with deformity correction for spinal stenosis with balanced de novo degenerative lumbar scoliosis: A Meta-analysis of direct comparative studies. Spine (Phila Pa 1976), 2017, 42(19): E1126-E1132.
5.	Bao H, Yan P, Qiu Y, et al. Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J, 2016, 98-B(9): 1227-1233.
6.	李彥明, 李明, 楊長偉. 退行性脊柱側凸患者冠狀面和矢狀面影像學參數分析. 中國脊柱脊髓雜志, 2016, 26(12): 1093-1098.
7.	Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus, 2010, 28(3): E1.
8.	Faldini C, Di Martino A, De Fine M, et al. Current classification systems for adult degenerative scoliosis. Musculoskelet Surg, 2013, 97(1): 1-8.
9.	Sun Y, Shen Y, Ding W, et al. Comparison in clinical outcome of two surgical treatments in degenerative scoliosis. Cell Biochem Biophys, 2014, 70(1): 189-193.
10.	Lee BH, Park JO, Kim HS, et al. Spinal sagittal balance status affects postoperative actual falls and quality of life after decompression and fusion in-situ surgery in patients with lumbar spinal stenosis. Clin Neurol Neurosurg, 2016, 148: 52-59.
11.	Liu H, Li S, Wang J, et al. An analysis of spinopelvic sagittal alignment after lumbar lordosis reconstruction for degenerative spinal diseases: how much balance can be obtained? Spine (Phila Pa 1976), 2014, 39(26 Spec No.): B52-B59.
12.	Farrokhi MR, Jamali M, Gholami M, et al. Clinical and radiological outcomes after decompression and posterior fusion in patients with degenerative scoliosis. Br J Neurosurg, 2017, 31(5): 514-525.
13.	鄭杰, 楊永宏, 張冬生, 等. 退變性脊柱側凸不同方式長節段固定融合術后鄰近節段生物力學變化的有限元分析. 中國脊柱脊髓雜志, 2011, 21(9): 769-773.
14.	張希諾, 孫祥耀, 海涌. 成人退行性脊柱側凸長節段融合術后內科并發癥危險因素分析. 中國骨與關節雜志, 2018, 7(10): 725-730.
15.	Zhang XN, Sun XY, Meng XL, et al. Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis. Int Orthop, 2018, 42(11): 2603-2612.
16.	Smith MW, Annis P, Lawrence BD, et al. Early proximal junctional failure in patients with preoperative sagittal imbalance. Evid Based Spine Care J, 2013, 4(2): 163-164.
17.	Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976), 2012, 37(12): 1077-1082.
18.	Shahidi B, Hubbard JC, Gibbons MC, et al. Lumbar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology. J Orthop Res, 2017, 35(12): 2700-2706.
19.	袁磊, 陳蕭霖, 曾巖, 等. 退變性腰椎側凸患者椎旁肌退變與術后近端交界性后凸的相關性研究. 中國脊柱脊髓雜志, 2018, 28(5): 425-433.
20.	Kim YJ, Bridwell KH, Lenke LG, et al. Is the T9, T11, or L1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L5 or S1? Spine (Phila Pa 1976), 2007, 32(24): 2653-2661.
21.	張希諾, 海涌, 孟祥龍, 等. 成人退變性脊柱側凸后路長節段融合內固定術后相關并發癥的危險因素. 中華骨科雜志, 2019, 39(16): 1003-1012.
22.	Bae J, Theologis AA, Strom R, et al. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine, 2018, 28(1): 40-49.

1. York PJ, Kim HJ. Degenerative scoliosis. Curr Rev Musculoskelet Med, 2017, 10(4): 547-558.
2. Dohzono S, Toyoda H, Hori Y, et al. Spinopelvic sagittal alignment after microendoscopic laminotomy in patients with lumbar degenerative spondylolisthesis. J Neurol Surg A Cent Eur Neurosurg, 2018, 79(6): 479-485.
3. Phan K, Xu J, Maharaj MM, et al. Outcomes of short fusion versus long fusion for adult degenerative scoliosis: A systematic review and Meta-analysis. Orthop Surg, 2017, 9(4): 342-349.
4. Lee CH, Chung CK, Sohn MJ, et al. Short limited fusion versus long fusion with deformity correction for spinal stenosis with balanced de novo degenerative lumbar scoliosis: A Meta-analysis of direct comparative studies. Spine (Phila Pa 1976), 2017, 42(19): E1126-E1132.
5. Bao H, Yan P, Qiu Y, et al. Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J, 2016, 98-B(9): 1227-1233.
6. 李彥明, 李明, 楊長偉. 退行性脊柱側凸患者冠狀面和矢狀面影像學參數分析. 中國脊柱脊髓雜志, 2016, 26(12): 1093-1098.
7. Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus, 2010, 28(3): E1.
8. Faldini C, Di Martino A, De Fine M, et al. Current classification systems for adult degenerative scoliosis. Musculoskelet Surg, 2013, 97(1): 1-8.
9. Sun Y, Shen Y, Ding W, et al. Comparison in clinical outcome of two surgical treatments in degenerative scoliosis. Cell Biochem Biophys, 2014, 70(1): 189-193.
10. Lee BH, Park JO, Kim HS, et al. Spinal sagittal balance status affects postoperative actual falls and quality of life after decompression and fusion in-situ surgery in patients with lumbar spinal stenosis. Clin Neurol Neurosurg, 2016, 148: 52-59.
11. Liu H, Li S, Wang J, et al. An analysis of spinopelvic sagittal alignment after lumbar lordosis reconstruction for degenerative spinal diseases: how much balance can be obtained? Spine (Phila Pa 1976), 2014, 39(26 Spec No.): B52-B59.
12. Farrokhi MR, Jamali M, Gholami M, et al. Clinical and radiological outcomes after decompression and posterior fusion in patients with degenerative scoliosis. Br J Neurosurg, 2017, 31(5): 514-525.
13. 鄭杰, 楊永宏, 張冬生, 等. 退變性脊柱側凸不同方式長節段固定融合術后鄰近節段生物力學變化的有限元分析. 中國脊柱脊髓雜志, 2011, 21(9): 769-773.
14. 張希諾, 孫祥耀, 海涌. 成人退行性脊柱側凸長節段融合術后內科并發癥危險因素分析. 中國骨與關節雜志, 2018, 7(10): 725-730.
15. Zhang XN, Sun XY, Meng XL, et al. Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis. Int Orthop, 2018, 42(11): 2603-2612.
16. Smith MW, Annis P, Lawrence BD, et al. Early proximal junctional failure in patients with preoperative sagittal imbalance. Evid Based Spine Care J, 2013, 4(2): 163-164.
17. Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976), 2012, 37(12): 1077-1082.
18. Shahidi B, Hubbard JC, Gibbons MC, et al. Lumbar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology. J Orthop Res, 2017, 35(12): 2700-2706.
19. 袁磊, 陳蕭霖, 曾巖, 等. 退變性腰椎側凸患者椎旁肌退變與術后近端交界性后凸的相關性研究. 中國脊柱脊髓雜志, 2018, 28(5): 425-433.
20. Kim YJ, Bridwell KH, Lenke LG, et al. Is the T9, T11, or L1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L5 or S1? Spine (Phila Pa 1976), 2007, 32(24): 2653-2661.
21. 張希諾, 海涌, 孟祥龍, 等. 成人退變性脊柱側凸后路長節段融合內固定術后相關并發癥的危險因素. 中華骨科雜志, 2019, 39(16): 1003-1012.
22. Bae J, Theologis AA, Strom R, et al. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine, 2018, 28(1): 40-49.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of short fusion versus long fusion for degenerative scoliosis with a Cobb angle of 20-40° combined with spinal stenosis

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