Limited long-segment fusion for degenerative lower lumbar scoliosis: a special kind of scoliosis

Du, Jinlin; Tang, Xiangyu; Li, Ningdao; Zhang, Lin; Zhang, Xifeng

doi:10.1007/s00264-016-3128-0

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…[22–25] With the complexity of the disease features of ADS and various best treatment methods for different cases, the surgical treatment strategies of ADS are currently controversial. [14]…”

Section: Discussionmentioning

confidence: 99%

“…Previously, scholars have classified all DS patients using different systems such as the Schwab, Scoliosis Research Society, [26] Ploumis, Faldini, Simmons, and coronal imbalance classifications. [14] Moreover, the Lenke-Silva classification, a system proposed by Silva and Lenke [2] dividing the surgical treatments into six levels, has been the most commonly used system in choosing the type of surgery. In Lenke-Silva type VI ADS, long-segment decompression/fusion and osteotomy are required for correction of sagittal imbalance.…”

Section: Discussionmentioning

confidence: 99%

“…Positive balance was defined in the case of the plumb line in the front; otherwise, negative balance was considered. [14] LL was measured as the angle from the upper endplate of L1 to the endplate of S1. [11]…”

Section: Methodsmentioning

confidence: 99%

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Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis

Zhang

Yang

et al. 2019

Chinese Medical Journal

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis

Zhang

Yang

et al. 2019

Chinese Medical Journal

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“…In total, 32 full-text articles were assessed for eligibility, and 25 were excluded because they were a 'case report or case study without a comparison, a review article, a debate, an article from the same site as another included study, or other reasons'. Finally, seven non-random comparative studies [16][17][18][19][20][21][22] were included in this meta-analysis. The included studies are shown in figure 1 (PRISMA flow diagram).…”

Section: Literature Searchmentioning

confidence: 99%

Long fusion correction of degenerative adult spinal deformity and the selection of the upper or lower thoracic region as the site of proximal instrumentation: a systematic review and meta-analysis

Sun

Harris

et al. 2016

BMJ Open

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Methods: MEDLINE, Embase and Cochrane library searches were performed to identify studies that compared outcome measures when the upper and lower thoracic vertebrae (UTV and LTV, respectively) were used as the site of proximal instrumentation. The weighted mean difference (WMD) was calculated for continuous outcomes, and the relative risk (RR) was calculated for dichotomous outcomes.Results: Seven articles (n=554 patients) met the final inclusion criteria, and we compared the outcome measures of a long fusion extending to the upper and lower thoracic regions. The pooled analysis revealed that extending fixation into the upper thoracic region decreased the risk of proximal junctional kyphosis (PJK) revision surgery (RR: 0.36, 95% CI 0.14 to 0.90, p<0.05). The operation time (WMD: 0.93, 95% CI 0.48 to 1.39, p<0.05) and estimated blood loss (WMD: 0.59, 95% CI 0.33 to 0.85, p<0.05) were significantly greater in the UTV group than in the LTV group. No significant differences were found in the Scoliosis Research Society pain, self-image, function, mental health, subtotal, satisfaction or total scores; the total number of complications or the total number of revision surgeries.Conclusions: Long posterior fixation extending into the upper thoracic region reduces the incidence of revision surgery related to PJK; however, it increased the operative level resulting in a longer operative time and greater estimated blood loss. This initial analysis indicates that extending fixation to the upper thoracic region is appropriate for patients who are likely to develop PJK following initial scoliosis correction.

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“…The use of pedicle screws was at first controversial and indeed at first during meetings in the United States cautions were given as their use had not been initially approved by the FDA. However they are now the main stay of attachment of instrumentation to the axial skeleton, especially in the treatment of fractures and deformity [1][2][3][4][5][6][7][8][9]. The last decade or two has also seen improvements in interbody cages and the re-emergence of anterior techniques to approach the spine [10,11].…”

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confidence: 99%

Spinal Special Edition Editorial

Quaile

2016

International Orthopaedics (SICOT)

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Limited long-segment fusion for degenerative lower lumbar scoliosis: a special kind of scoliosis

Abstract: Limited long-segment fusion is effective for patients with degenerative lower lumbar scoliosis without severe thoracolumbar kyphosis.

Cited by 6 publications

References 11 publications

Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis

Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis

Long fusion correction of degenerative adult spinal deformity and the selection of the upper or lower thoracic region as the site of proximal instrumentation: a systematic review and meta-analysis

Spinal Special Edition Editorial

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