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

Abstract

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.

“Reasonable threshold” of spinopelvic parameters after fixation on distal stenosis in patients with degenerative thoracolumbar kyphosis: A STROBE-compliant article

“…[ 17 , 18 ] Moreover, long-segment fixation is accompanied with higher cost, longer operation time, extensive incision, and sometimes with lumbosacral osteotomy, ensuing with longer recovery duration and probable higher complication rate. [ 15 ] Therefore, for LSS patient with DTLK, this study hypothesized short-segmental fixation on LSS can still bring satisfactory efficacy with a more tolerate “reasonable threshold” of parameters.…”

“…Contrasted to SRS-Schwab classification, [6] Lenke-Silva classification may take excessive measures to patients, largely due to the missing consideration of physical degenerative factors. [5,15] Hence, more age-related formulas appeared in order to readjust the threshold of sagittal parameters, especially for the elder. [9,16] Physically, the LL of older was less than the young with a more adaptive PI-LL.…”

Treatment of patients with degenerative deformities of the lumbar spine using MIS technologies: analysis of 5-year results

“…Применение минимально-инвазивных хирургических технологий сопровождается меньшим количеством послеоперационных осложнений [21]. При этом в большинстве исследований спондилодез был подразделен на короткосегментарный (до трех уровней включительно) и протяженный (более трех уровней) с попыткой исправления деформации [7,[22][23][24].…”

Limited surgery assisted by ultrasound-guided selective nerve root block for the treatment of degenerative scoliosis: a preliminary clinical report

“…Degenerative Scoliosis (DS) is de ned as the degeneration of the intervertebral disc and facet joints resulting in a Cobb angle > 10° in the coronal plane of the spine [1].The main clinical manifestations of DS include low back pain, scoliosis, and nerve root compression symptoms [2,3]. Due to the complexity of its disease characteristics and the concept of individualized treatment, the current treatment strategy for DS remains controversial [4][5][6]; in particular,spinal joint degeneration and osteoporosis aggravate with increasing age, which is also accompanied by cardiopulmonary insu ciency and other system complications [7].Therefore, most patients with DS have a low tolerance for surgical trauma, which requires the selection of treatment options to minimize this trauma [8]. This leads to a di cult problem in the clinical treatment of DS; namely, solving the most critical problems through limited surgeries.…”