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Is It Real Adjacent Segment Pathology by Stress Concentration After Limited Fusion in Degenerative Lumbar Scoliosis?

Ha, Kee-Yong MD; Kim, Young-Hoon MD; Ahn, Joo-Hyun MD

doi: 10.1097/BRS.0000000000000331
Deformity
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Study Design. A retrospective comparative study.

Objective. To investigate adjacent segment pathology (ASP) after limited lumbar fusion in the treatment of degenerative lumbar scoliosis (DLS).

Summary of Background Data. The assessment of appropriate surgical techniques for DLS remains one of the most controversial topics in spinal surgery. So far, there has been no study specifically addressing why ASP shows different patterns with respect to different fusion levels after instrumented lumbar fusion for DLS.

Methods. Fifty-nine patients were enrolled and divided into 2 groups with respect to the proximal fusion level: group I consisted of 29 patients who underwent fusion below the proximal neutral vertebrae, and group II consisted of 30 patients who underwent fusion to the proximal neutral vertebrae. Clinical and radiological assessments were performed with an average of 59.4 months of follow-up. The number of radiological findings for ASP was determined on the basis of a 7-point scale that gave 1 point for each radiological finding. The 2 groups were analyzed according to radiological ASP (RASP). The Oswestry Disability Index and visual analogue scale scores were recorded prospectively.

Results. Overall, RASP developed in 16 (27.1%) patients. In group I, 12 (41.4%) of 29 patients, and in group II, 4 (13.3%) of 30 patients showed RASP. Group I yielded an average of 4.5 points, and group II, 1.8 points. RASP scores were much higher in group I than in group II, with statistical significance (P = 0.000). In group I, 4 patients underwent revision surgery, but in group II, only 1 patient did so.

Conclusion. RASP displayed variance according to different fusion levels. RASP in group I showed similar patterns to the natural progression of DLS. It is suggested that fusion be included at least at the proximal neutral vertebrae to reduce RASP although RASP with different patterns is unavoidable.

Level of Evidence: 4

Fifty-nine patients with degenerative lumbar scoliosis were divided into 2 groups: group I patients underwent fusion below the proximal neutral vertebrae, whereas group II patients underwent fusion to the proximal neutral vertebrae. Overall, 16 patients (27.1%) showed radiological adjacent segment pathology (RASP), but RASP yielded different patterns with respect to different fusion levels.

From the Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address correspondence and reprint requests to Kee-Yong Ha, MD, Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Gu, 137-701, Seoul, Korea; E-mail: kyh@catholic.ac.kr

Acknowledgment date: October 27, 2013. First revision date: January 3, 2014. Acceptancve date: January 20, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins