Comparation in outcome of long segment fusion versus short segment fusion for the treatment of adult degenerative scoliosis

Abstract

Objective To investigate the effect of decompression with long-segment (L) or short-segment (S) fusion on the outcomes of the surgical treatment for degenerative adult scoliosis (ADS) patiens. Methods A retrospective study on 32 patients treated in our department for ADS from April 2013 to May 2015 was carried out, including 12 male and 20 female (1∶1.7). Their average age was 66.4 (range: 51-77 years). All patients underwent decompression and fusion surgeries through posterior approach. They were divided into long-segment fusion group (L) and short-segment fusion group (S) according to fusion range. During follow-ups (FU), clinical outcomes were assessed by means of visual analog scale (VAS) and Oswestry disability index (ODI). Radiographic evaluation on full-length standing film included coronal Cobb's angle, distant between C7 plumb line and center sacral vertical line (C7PL-CSVL), thoracic kyphosis(TK) angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT), PI-LL, sagittal vertical axis(SVA). Postoperative complications were also recorded. Results All patients were followed up for average 2.2 years (range: 1.5-3.5 years). No significant difference of age or gender was found between two groups (L: 22, S: 10) of patients (P=0.066, 0.182). As for the fusion segments, group L (6.3±1.5) was more than group S (2.9±0.3) (P=0.001). Operation time and blood loss of group L were statistically more than group S (P 0.05); at the final FU, group L's ODI showed better functional recovery than group S's〔(12.8±9.3)% vs.(25.4±11.4)%, P 0.05), coronal Cobb's angle corrected more satisfactional in group L than group S (P<0.05). The same situation was found in C7-CSVL correction in two goup in FU (P<0.05). Sagital balance was restored to normal alignment better in group L than group S, with increase of lumbar lordosis after surgery. The overall incidence of postoperative complications was 31.3%, including wound infection, cerebrospinal fluid leakage, transient neurological symptoms and internal fixed rod breakage, more common in group L than group S. Conclusions Decompression and fusion with internal fixation showed good clinical outcomes in the treatment of ADS. Long-segment fusion yielded better coronal and sagittal correction outcomes with higher peri-operation risks; however, short-segment fusion showed higher safety with relatively inferior correction effect. Appropriate fusion mode should be chose according to the patient's deformity features. Key words: Scoliosis; Spinal fusion; Internal fixators