INTRODUCTION: This study aimed to compare clinical and radiographic outcomes between long corrective fusion and short‐segment fusion for degenerative lumbar scoliosis with global spinal imbalance.
METHODS: Of 81 patients with degenerative lumbar scoliosis who underwent surgeries, 28 patients (35%) had global spinal imbalance defined by SRS Adult Deformity Classification: C7 plumb line (C7PL) >5cm anterior to sacral promontory, or >3cm lateral to central sacral vertical line). They were divided into two groups: fusion within the main curve (short fusion, n=13) and corrective fusion encompassing the main curve (long fusion, n=15). Operation time was 221 minutes in short fusion versus 284 minutes in long fusion; estimated blood loss was 533 mL and 737 mL, respectively. Follow‐up period was 18 months on average. Clinical outcomes and radiographic parameters were compared between the two groups.
RESULTS: At the final follow‐up, visual analog scales of back pain and leg pain were averaged to 44/100 and 40/100 in short fusion, and 30/100 and 25/100 in long fusion, respectively. Deterioration of global spinal imbalance (>1cm increase in coronal C7PL deviation or >3cm increase in sagittal C7PL deviation) was observed in 9 patients (69%) in short fusion and 5 patients (33%) in long fusion. In short fusion group, residual scoliosis was 8.2 degrees immediately after surgery, and progressed to 18.0 degrees at the final follow‐up; revision surgery was required in three patients (23%) in short fusion due to curve progression. Two patients (13%) in long fusion required extension of fusion due to VCF or failure of fixation.
DISCUSSION: In the surgical management of degenerative lumbar scoliosis with global spinal imbalance, long corrective fusion had advantages to reduce risks of deterioration of global spinal imbalance and residual curve progression. Revision surgery was related to curve progression in short‐segment fusion, and VCF or failure of fixation in long fusion.