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Long‐Term Follow‐Up Study of Unfused Segments of Idiopathic Scoliosis: Evaluation of X‐Ray and MRI Images after More than 10 Years Postoperative: *Paper #8

Kawakami, Noriaki MD; Seki, Kenji MD, PhD; Tsuji, Taichi MD; Mlyasaka, Kazuyoshi MD; Ohara, Tetsuya; Nohara, Ayato; Sato, Michiyoshi; Ito, Kenyu

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Japan

Summary: This retrospective study was conducted to investigate the existence of disc degeneration (DD) in distal unfused segments and clinical outcomes over follow‐up (F/U) periods of more than 10 years. 61 patients who matched the inclusion criteria: age at op. 11‐25 years, AIS, MRI and X‐ray images, and postop. F/U period of more than 10 years. Although patients did not exhibit any significant symptoms, DD was found in 42.6% patients, 76.9% of DD was located on the L4/5 or L5/S1.

Introduction: The purpose of this study was to investigate the existence of DD in distal unfused segments and clinical outcomes in IS over F/U Siperiods of more than 10 years.

Methods: This was a retrospective study. For 10 years from 1990 to 1999, 307 scoliosis patients underwent surgical correction. Of them, 61 patients (male 3, female 28) matched the inclusion criteria: 1) age at op. 11‐25 years, 2) adolescent IS, 3) MRI and X‐ray images, 4) postoperative F/U more than 10 years. Preop., postop., and final F/U main and lumbar curves, DD according to Pfirmann's grading system, and SRS‐30 were evaluated by a spine surgeon who neither operated on the patients nor performed routine postop. check‐ups on them.

Results: Patients ages were 15.2 at the time of op. and 27.1 years at F/U. Preop., Postop, and final F/U main scolioses were 59.0°, 22.7° and 25.2°, respectively. Lumbar curves were 38.7°, 16.0°, and 17.2°. Sagittal curves did not show any significant changes. 38 discs of 261 (14.6%) showed DD (Grade III‐21, IV‐17). 30 of 39 had degenerated discs on L4/5 (11) or L5/S1 (19). Of the Grade IV degenerated discs, 2 were lower adjacent to the fusion segments and 11 were located on L5/S1. 26 patients (42.6%) showed DD at the final F/U time (D‐group) and the final scoliosis angle (30.0°) was significantly higher than those who did not show any DD (N‐group, 21.5°) (p=0.004). Lumbar curve magnitude did not show any significant difference between the two groups. The number of distal mobile segments in group D was significantly less than that of N‐group (p=0.03). Clinical outcomes evaluated with SRS‐30 also demonstrated no significant difference between two groups.

Conclusion: Surgical correction and fusion of AIS provided good clinical outcomes for more than 10 years. Although patients did not exhibit any significant symptoms, DD was found in 42.6% patients, 76.9% of DD was located on the L4/5 or L5/S1.

Significance: Patients did not exhibit any significant symptoms during postop. F/U period more than 10 years, DD was found in 42.6% patients, 76.9% of DD was located on the L4/5 or L5/S1.

© 2010 Lippincott Williams & Wilkins, Inc.

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