Comparison of Short Fusion versus Long Fusion for Degenerative Lumbar Scoliosis

Abstract

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.

Radiologic and Clinical Courses of Degenerative Lumbar Scoliosis (10°–25°) after a Short-Segment Fusion

“…1 ). In the present study, the largest increase in the correction loss occurred between 6 and 12 months after surgery, which concurs with the findings of Cho et al [ 11 ] and Hwang et al [ 12 ].…”

“…Tribus [ 3 ] recommended fusion of decompressed segments in patients without coronal or sagittal imbalance, and proposed long-segment fusion for patients with a large Cobb's angle or coronal or sagittal imbalance. Cho et al [ 11 ] reported that long fusion and instrumentation are more effective than short fusion for correcting scoliotic angle and coronal imbalances, and considered long fusion more effective than short fusion in patients with a Cobb's angle of >25°. In contrast, Simmons [ 9 ] stated that long fusion was unnecessary to correct scoliosis deformities and that back pain and stenosis may disappear when the spinal balance is maintained by a short fusion.…”

“…Based on previous studies, patients were divided into a short-segment fusion and a long-segment fusion based on a Cobb's angle of 25°. Small DLS was defined as a DLS with a Cobb's angle between 10° and 25° [ 11 ]. We aimed to identify changes immediately and subsequently after surgery by measuring the Cobb's angle, 1 and 2 segment coronal UIA-1 and -2, 1 and 2 segment sagittal UIA-1 and -2, lumbar lordotic curves, and coronal and sagittal vertical axes (the coronal and sagittal C7 plumb line) based upon radiological outcomes.…”

“…However, fusion to the sacrum has the disadvantages of more complicated surgical procedures and an increased risk of non-union at the lumbar/sacral boundary. Cho et al [ 11 ] reported that secondary degenerative changes were commonly observed between L5 and S1 during follow-up. Aebi [ 8 ] reported that the non-union did not occur after additional posterior interbody fusion at the lumbar/sacral junction.…”

“…One of the disadvantages of a short fusion is the higher incidence of adjacent segment disease, which occurs more frequently in proximal segments. Since both coronal deformity and imbalance are corrected by long fusions, the incidence of adjacent segment disease is lower compared to that by short fusions [ 11 ]. The present study compared radiologic changes and clinical outcomes of proximal segments postoperatively using VAS pain scores.…”