Short-Segment versus Long-Segment Spinal Fusion Constructs for the Treatment of Adult Degenerative Scoliosis: A Comparison of Clinical Outcomes

Abstract

To compare clinical outcomes of patients diagnosed with degenerative scoliosis undergoing short-segment versus long-segment spinal fusion. A retrospective cohort study was conducted of patients with degenerative thoracolumbar scoliosis undergoing elective spinal fusion at a single academic medical center. Cohorts were divided into short-segment (<3) or long-segment (≥3) groups. A total of 197 patients (122 short, 75 long) were included. Patients undergoing short-segment fusion more frequently presented with radiculopathy (P < 0.001) and had greater baseline visual analog scale (VAS) leg scores (P < 0.001). Patients with long-segment fusions had longer hospital length of stay (short, 3.82 ± 2.98 vs. long, 7.40 ± 6.85 days; P < 0.001), lower home discharge rates (short, 80.3% vs. long, 51.8; P= 0.003), higher revision surgery rates (short, 10.77% vs. long, 25.3%; P= 0.012), and greater percentage curve correction (short, 37.3% ± 25.9% vs. long, 45.1% ± 23.9%; P= 0.048). No significant differences were noted in postoperative complication rates (short, 1.64% vs. long, 5.33%; P= 0.143). At 1 year, patients with long fusions had worse ΔOswestry Disability Index (ODI) (P= 0.024), ΔVAS leg score (P= 0.002), and VAS leg minimum clinically important difference % (P= 0.003). Multivariate regression found that short-segment fusions were associated with greater improvements in ODI (P= 0.029), Physical Component Summary-12 (P= 0.024), and VAS leg score at 1 year (P= 0.002). Patients undergoing short-segment fusions more frequently presented with radiculopathy and had higher preoperative VAS leg scores compared with those receiving long constructs. Short-construct fusions in appropriately selected patients may provide satisfactory improvements in patient-reported outcome measures, particularly ΔODI and ΔVAS leg score, and mitigate hospital length of stay, revision surgery rates, and nonhome discharge.