RESUMEN
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 ( P0.05). The Cobb angle, SVA, TLK, and PT significantly decreased, while SS and LL significantly increased in the long fusion group ( P0.05). 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.
RESUMEN
Background@#The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS.@*Methods@#Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test.@*Results@#The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ± 5.4 mm vs. 47.5 ± 7.6 mm, t = -8.066, P < 0.001), PT (14.7 ± 1.8° vs. 29.1 ± 3.4°, t = -13.277, P < 0.001), and SS (39.8 ± 7.2° vs. 26.1 ± 3.3°, t = 6.175, P < 0.001) between the long and short fusion groups. All patients had improved ODI, JOA, and VAS scores post-operatively (all P < 0.001), with no significant difference between the groups (all P > 0.05). The post-operative LSDI score was 3.5 ± 0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ± 0.7; P < 0.001).@*Conclusions@#The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.
RESUMEN
PURPOSE: To compare the results of short fusion versus long fusion for degenerative lumbar scoliosis. MATERIALS AND METHODS: Forty-seven patients undergoing short fusion (n=28) and long fusion and instrumentation (n=19) were evaluated. Short fusion was defined as fusion within the deformity, not exceeding the upper end vertebra. Long fusion was defined as fusion extended above the upper end vertebra. The number of levels fused in the short and long fusion groups was 3.14 and 6.89 segments, respectively. RESULTS: Before surgery, the Cobb angle was 16.3 degrees in the short fusion group and 22 degrees in the long fusion group, which changed to 10.1 degrees and 8.47 degrees, respectively, at the last visit. The correction of coronal imbalance was better in the long fusion group. In contrast, the correction of sagittal imbalance was similar in both groups. The mean estimated blood loss in the short and long fusion groups was 1,671 ml and 2,742 ml, respectively. Early perioperative complications developed frequently in the long fusion group. Adjacent segment disease occurred more frequently in the short fusion group. CONCLUSION: Long fusion and instrumentation for degenerative lumbar scoliosis was better at correcting the coronal deformity and imbalance than short fusion but was ineffective in correcting the sagittal imbalance.
Asunto(s)
Humanos , Anomalías Congénitas , Escoliosis , Columna VertebralRESUMEN
STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the fixation survival rate and the radiologic prognostic factors of posterior short fusion in thoracolumbar fracture. SUMMARY OF BACKGROUND DATA: Posterior short fusion has the advantage of saving motion segments in spite of high fixation failure rate. The high load-sharing score is well known as a cause of fixation failure, but the effect of osteopenia is not evaluated. MATERIALS AND METHODS: Authors evaluated 27 patients treated surgically with posterior short fusion using pedicle screws as thoracolumbar fractures from 1995 to 1999. The median follow-up was 20.5 months (6-54). The survivorship using Kaplan-Meier method and the radiologic prognostic factors were evaluated. RESULTS: The sagittal index was preoperatively 16.7 dgree (+/-7.9 SD), immediate postoperatively 6.9 dgree (+/-4.6), and at last follow-up 10.6 dgree (+/-6.9). The fixation failures were detected in 4 patients, and the failure time was ranged from 6 months to 11(median 7.5). The overall survival rate was 82.3% at the last follow-up. The significant prognostic variables were load-sharing score, Jikei grade, compression percent and age in uni-variate analysis, but the load-sharing score and Jikei grade were significant prog-nostic factors in multivariate analysis. CONCLUSIONS: In decision to perform posterior short fusion, the load-sharing score and evidence of osteopenia should be consid-ered as a prognostic factors to avoid fixation failure in thoracolumbar fracture.