Comparison of limited fusion and full curve fusion for mild lumbar degenerative scoliosis with stenosis

doi:10.3969/j.issn.2095-4344.1897

Abstract

Abstract:

BACKGROUND: Lumbar mild degenerative scoliosis with stenosis is a common disease; however, there is still controversy regarding to the surgical fixation range.

OBJECTIVE: To comparatively analyze the imaging and clinical effects of full curve fusion and limited fusion in patients with lumbar spinal stenosis accompanied by degenerative scoliosis.

METHODS: The historical cohort study consisted of 94 patients. Inclusion criteria were: degenerative scoliosis with Cobb’s angle over 10 degrees and not above 30 degrees. The main symptoms included low back pain, weakness of lower limbs or claudication. According to the length of fixed segments, they were divided into two groups: full curve fusion group (46 cases) and limited fusion group (48 cases). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Visual Analog Score of pain, Oswestry Disability Index, Roland Morris Scores and Japanese Orthopaedic Association Scores were assessed. Patient data including age, operation time, blood loss, length of instrumented segments, and Cobb angle were also analyzed.

RESULTS AND CONCLUSION: (1) The full curve fusion group had 1 more vertebra instrumented than the limited fusion group (P < 0.01). Although the operation time and bleeding volume of the full curve fusion group were greater than those of the limited fusion group, there was no significant difference (P > 0.05). (2) There was no significant difference in Cobb angle in the limited fusion group before and after operation (t=0.885, P=0.388). Cobb angle in the full curve fusion group was corrected from preoperatively (16.5±4.7) degrees to the final follow-up (9.2±6.2) degrees (t=7.095, P < 0.001). (3) Visual Analog Score of pain, Oswestry Disability Index, Roland Morris Scores and Japanese Orthopaedic Association Scores were significantly improved postoperatively compared with those preoperatively in both full curve fusion and limited fusion groups (all P ≤ 0.005). These indicated that the quality of life of patients after operation was significantly improved regardless of the type of surgery. There was no significant difference between the two groups (P > 0.05). In addition, the analysis of items of Oswestry Disability Index and Japanese Orthopaedic Association Scores found that compared with the limited fusion group, the walking ability was improved in the limited fusion group (P < 0.05). (4) Overall, the patients in the full curve fusion group had higher satisfaction at the final follow-up, but there was no significant difference in the problems between the two groups (P > 0.05). (5) It is suggested that there is no significant difference in the function and satisfaction of patients with lumbar spinal stenosis with mild degenerative scoliosis after full curve fusion and limited fusion, and the efficacy was comparable.

Key words: degenerative scoliosis, lumbar spinal stenosis, fixed fusion, full curve fusion, limited fusion, function, satisfaction

CLC Number:

R459.9|R318|R68

He Da, Zhao Jingwei, Liu Bo, Tian Wei. Comparison of limited fusion and full curve fusion for mild lumbar degenerative scoliosis with stenosis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(36): 5811-5817.

Figures/Tables 5

References

[1]Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J. 2007;7:428-436.

[2]Transfeldt EE, Topp R, Mehbod AA, et al. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine. 2010;35:1872-1875.

[3]袁宁,田伟,刘波,等.成人脊柱侧凸的手术治疗策略[J]. 骨科临床与研究杂志,2017,2(3):159-164.

[4]Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res. 2001; (384):45-53.

[5]Simmons EDJ, Simmons EH. Spinal stenosis with scoliosis. Spine (Phila Pa 1976). 1992;17:S117-120.

[6]Gupta MC. Degenerative scoliosis. Options for surgical management. Orthop Clin North Am. 2003;34:2692-79.

[7]Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28:E1.

[8]Aebi M. The adult scoliosis. Eur Spine J. 2005;14:925-948.

[9]Liu Z, Zhao QH, Wu XZ, et al. Short fusion and long fusion for degenerative lumbar scoliosis with lumbar stenosis. Zhonghua Yi Xue Za Zhi. 2012;92:1751-1755.

[10]Liu W, Chen XS, Jia LS, et al. The clinical features and surgical treatment of degenerative lumbar scoliosis: a review of 112 patients. Orthop Surg. 2009;1:176-183.

[11]Cho KJ, Suk SI, Park SR, et al. Short fusion versus long fusion for degenerative lumbar scoliosis. Eur Spine J. 2008;17:650-656.

[12]Kotwal S, Pumberger M, Hughes A, et al. Degenerative scoliosis: a review. HSS J. 2011;7:257-264.

[13]Bae HW, Rajaee SS, Kanim LE. Nationwide trends in the surgical management of lumbar spinal stenosis. Spine(Phila Pa 1976). 2013; 38:916-926.

[14]Hioki A, Miyamoto K, Kodama H, et al. Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis. Spine J. 2005;5:600-607.

[15]Bridwell KH. Selection of instrumentation and fusion levels for scoliosis: where to start and where to stop. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2004. J Neurosurg Spine. 2004;1:1-8.

[16]Birknes JK, White AP, Albert TJ, et al. Adult degenerative scoliosis: a review. Neurosurgery. 2008;63:94-103.

[17]Ploumis A, Liu H, Mehbod AA, et al. A correlation of radiographic and functional measurements in adult degenerative scoliosis . Spine (Phila Pa 1976). 2009;34:1581-1584.

[18]Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis . Spine (Phila Pa 1976). 2005;30:682-688.

[19]Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity . Spine (Phila Pa 1976). 2005; 30:2024-2029.

[20]Schwab F, Dubey A, Gamez L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population . Spine (Phila Pa 1976). 2005;30:1082-1085.

[21]Daubs MD, Lenke LG, Bridwell KH, et al. Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity? Spine (Phila Pa 1976). 2013;38:476-483.

[22]Zurbriggen C, Markwalder TM, Wyss S. Long-term results in patients treated with posterior instrumentation and fusion for degenerative scoliosis of the lumbar spine. ActaNeurochir (Wien). 1999;141:21-26.

[23]Weidenbaum M. Considerations for focused surgical intervention in the presence of adult spinal deformity . Spine (Phila Pa 1976). 2006;31: S139-143.

[24]Schwab FJ, Smith VA, Biserni M, et al. Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976). 2002;27: 387-392.

[25]Li F, Chen Q, Chen W, et al. Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis. J Spinal Disord Tech. 2011;24:308-312.

[26]Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J. 2001;10:314-319.

[27]Hai Y, Meng X. Selective Posterior Decompression and short segmental fusion of degenerative lumbar scoliosis. Spine J. 2010;10: S62-63.

[28]Ledonio CGT, Polly Jr. DW, Crawford III CH, et al. Adult Degenerative Scoliosis Surgical Outcomes: A Systematic Review and Meta-analysis. Spine Deform. 2013;1:248-258.

[29]Tsai TH, Huang TY, Lieu AS, et al. Functional outcome analysis: instrumented posterior lumbar interbody fusion for degenerative lumbar scoliosis. Acta Neurochir (Wien). 2011;153:547-555.

[30]Li F, Chen Q, Chen W, et al. Posterolateral lumbar fusion versus transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis. J Clin Neurosci. 2013;20:1241-1245.

[31]Cho KJ, Suk SI, Park SR, et al. Selection of proximal fusion level for adult degenerative lumbar scoliosis . Eur Spine J. 2013;22:394-401.

[32]Shufflebarger H, Suk SI, Mardjetko S. Debate: determining the upper instrumented vertebra in the management of adult degenerative scoliosis: stopping at T10 versus L1. Spine. 2006;31:S185-194.

[33]O'Shaughnessy BA, Bridwell KH, Lenke LG, et al. Does a long-fusion "T3-sacrum" portend a worse outcome than a short-fusion "T10-sacrum" in primary surgery for adult scoliosis? Spine. 2012;37: 884-890.