Biblioteca Virtual en Salud

Objective To investigate the effect of decompression with long-segment (L) or short-segment (S) fusion on the outcomes of the surgical treatment for degenerative adult scoliosis (ADS) patiens.Methods A retrospective study on 32 patients treated in our department for ADS from April 2013 to May 2015 was carried out, including 12 male and 20 female (1 1.7).Their average age was 66.4 (range 51-77 years).All patients underwent decompression and fusion surgeries through posterior approach.They were divided into long-segment fusion group (L) and short-segment fusion group (S) according to fusion range.During follow-ups (FU), clinical outcomes were assessed by means of visual analog scale (VAS) and Oswestry disability index (ODI).Radiographic evaluation on full-length standing film included coronal Cobb's angle, distant between C7plumb line and center sacral vertical line (C7PL-CSVL), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT), PI-LL, sagittal vertical axis(SVA).Postoperative complications were also recorded.Results All patients were followed up for average 2.2 years (range1.5-3.5 years).No significant difference of age or gender was found between two groups (L 22, S10) of patients (P=0.066, 0.182).As for the fusion segments, group L (6.3±1.5) was more than group S (2.9±0.3) (P=0.001).Operation time and blood loss of group L were statistically more than group S (P＜0.05).Postoperative VAS sores of back pain and leg pain as well as ODI were all improved significantly in two groups (P＜0.05).At the final FU, back pain VAS was more in group L than in group S (P＜0.05) , but no significant difference was found in leg pain VAS between two groups (P＞0.05);at the final FU, group L's ODI showed better functional recovery than group S's[(12.8±9.3)％ vs.(25.4±11.4)％, P＜0.05].With no obvious difference in the two groups (P＞0.05), coronal Cobb's angle corrected more satisfactional in group L than group S (P＜0.05).The same situation was found in C7-CSVL correction in two goup in FU (P＜0.05).Sagital balance was restored to normal alignment better in group L than group S, with increase of lumbar lordosis after surgery.The overall incidence of postoperative complications was 31.3％, including wound infection, cerebrospinal fluid leakage, transient neurological symptoms and internal fixed rod breakage, more common in group L than group S.Conclusions Decompression and fusion with internal fixation showed good clinical outcomes in the treatment of ADS.Long-segment fusion yielded better coronal and sagittal correction outcomes with higher peri-operation risks;however, short-segment fusion showed higher safety with relatively inferior correction effect.Appropriate fusion mode should be chose according to the patient's deformity features.