Cervical degenerative changes in idiopathic scoliosis patients who underwent long fusion to the sacrum as adults: incidence, severity, and evolution

Elisha Ofiram,Timothy A Garvey,Robert B Winter,Jill M Wroblewski,James D Schwender

doi:10.1007/s10195-008-0044-0

Elisha Ofiram, Timothy A Garvey + Show 3 more

Open Access

https://doi.org/10.1007/s10195-008-0044-0

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Abstract

BackgroundTo date, there have been no published studies of the degenerative changes in the cervical spine in adult idiopathic scoliosis patients with thoracic and lumbar curves severe enough to require major reconstructive surgery.Materials and methodsThe primary study group was 48 adult patients who had previously undergone a fusion from T10 or higher to the sacrum as an adult for idiopathic scoliosis. These were compared to 38 adults with unfused idiopathic scoliosis of 30°–50° and to 42 symptomatic adults presenting with cervical pain. Cervical degeneration was assessed using a new cervical degenerative index (CDI).ResultsThe amount of degenerative change seen in the cervical spine in the long-fusion group was significantly higher at baseline (just prior to the fusion) than the two control populations and became much higher at a mean follow-up of 8.5 years.ConclusionsThis unique subgroup of patients, those having fusion from the thoracic spine to the sacrum as adults for adolescent idiopathic scoliosis, had a high incidence and severity of degenerative changes in their cervical spine. Due to the presence of advanced cervical degenerative changes prior to the fusion, it is not possible to blame the fusion as the main cause for these findings. These changes are either related to the thoracic and lumbar deformities or are more likely due to this subgroup having a higher natural propensity for degenerative changes.

Highlights

The subject of degenerative changes in adjacent segments following spine fusion has been of considerable interest with a multitude of published studies in the lumbar fusion, cervical fusion, and deformity fusion literature [1, 2]
There is no study in the literature evaluating degenerative changes in the cervical spine following long fusion to the sacrum for symptomatic idiopathic scoliosis
We have chosen to study three patient populations: a group of 48 adults who had a spine fusion from the thoracic spine to the sacrum for scoliosis, a group of 38 adults with unfused idiopathic scoliosis of 30–50°, and a group of 42 adults presenting to our clinic with cervical complaints, but no scoliosis

Summary

Introduction

The subject of degenerative changes in adjacent segments following spine fusion has been of considerable interest with a multitude of published studies in the lumbar fusion, cervical fusion, and deformity fusion literature [1, 2]. We have chosen to study three patient populations: a group of 48 adults who had a spine fusion from the thoracic spine to the sacrum for scoliosis, a group of 38 adults with unfused idiopathic scoliosis of 30–50°, and a group of 42 adults presenting to our clinic with cervical complaints, but no scoliosis. These groups were compared using a new cervical degenerative index (CDI) [3]. Results The amount of degenerative change seen in the cervical spine in the long-fusion group was significantly higher at baseline (just prior to the fusion) than the two control populations and became much higher at a mean follow-up of 8.5 years

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