Restoration of the difference value of pelvic incidence and lumbar lordosis in degenerative scoliosis patients: its influence in maintaining sagittal profile and improving quality of life / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the role that post-operative difference value of pelvic incidence and lumbar lordosis (PI-LL) played on loss of correction, implant failure and health-related quality of life during follow-up in degenerative scoliosis patients.</p><p><b>METHODS</b>Retrospective review of 62 patients (average age (57 ± 10) years, 11 male and 51 female patients) with degenerative scoliosis who underwent one stage posterior surgical instrumentation in the affiliated Drum Tower Hospital of Nanjing University Medical School from January 2005 to December 2011. The mean follow-up duration was 4.2 years. Long-cassette standing upright sagittal radiographs were obtained before and after operation and at the last follow-up. At the last follow-up, visual analogue scale and Oswestry disability index were collected. Based on post-operative PI-LL, patients were divided into two groups: group A (-9° < post-operative PI-LL<9°) and group B (post-operative PI-LL < -9°or post-operative PI-LL>9°). Independent t test and χ(2) test were performed for statistical analysis. For all statistical analysis, the level of significance was set at P < 0.05.</p><p><b>RESULTS</b>No difference was observed in terms of loss of correction between two groups during follow-up. More implant failure were observed in group B (15.63% vs. 6.7%, χ(2) = 21.85, P = 0.012). In addition, patients with better PI-LL matching came with better visual analogue scale (3.9 ± 2.4 vs. 5.2 ± 3.3, F = 0.089, P = 0.024).</p><p><b>CONCLUSION</b>Worse quality of life and increased risk for implant failure during follow-up may be related to mismatched PI-LL.</p>

Effect of intervertebral disc degeneration on spinal flexibility in patients with degenerative lumbar scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate degenerative changes of the intervertebral disc and their impact on spinal flexibility in patients with degenerative lumbar scoliosis (DLS).</p><p><b>METHODS</b>Retrospective analysis of 66 patients (average age 58.4 years, 10 males and 56 females) with DLS was conducted from May 2008 to February 2014. For all patients, pre-operative standing X-ray film, Bending X-ray films and thoracolumbar MRI were taken. Cobb's angle was measured in each X-ray film and intervertebral angle was measured in both standing and Bending X-ray films. All discs were graded according to Pfirrmann degeneration grades on T2 weighted saggital MRI imaging. Statistical analyses were performed to determine the correlation between intervertebral disc degeneration with the whole spine flexibility and segmental flexibility.</p><p><b>RESULTS</b>For all 66 subjects, the average Cobb's angle of pre-operative and bending X-ray film was 36° ± 13°, 21° ± 11°, respectively. The average flexibility was 45% ± 15% in our study. Totally 268 discs were graded, including gradeI8, II 68, III 83, IV 91, V 18. In the main curve, there was significant correlation between the average degree of disc degeneration and the whole spine flexibility(r = -0.727, P < 0.01). There was significant correlation between the grade of segmental disc degeneration and segmental flexibility (P < 0.01) . The apical intervertebral disc had the most degeneration (P < 0.01) and worst flexibility (P < 0.01) , compared with other discs in the main curve.</p><p><b>CONCLUSIONS</b>The degree of intervertebral disc degeneration is closely correlated with spinal flexibility in DLS. The more the disc degeneration is, the worse the spinal flexibility becomes.</p>