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Burgos J, Hevia E, Sanpera I, García V, de Santos Moreno MT, Mariscal G, Barrios C. Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1624-1636. [PMID: 38372794 DOI: 10.1007/s00586-024-08165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/31/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE The objective of this meta-analysis was to determine the incidence of disc degeneration in patients with surgically treated adolescent idiopathic scoliosis (AIS) and identify the associated risk factors. METHODS PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched. The outcomes of interest were the incidence of disc degeneration, SRS-22, and radiological risk factors. The lower instrumented vertebra (LIV) was also evaluated. Fixed effects were used if there was no evidence of heterogeneity. Statistical analysis was performed using Review Manager. RESULTS A meta-analysis was conducted including nine studies with a total of 565 patients. The analysis revealed that the global incidence of intervertebral disc degeneration in patients with surgically treated AIS patients was 24.78% (95% CI 16.59-32.98%) 10 years after surgery, which significantly increased to 32.32% (95% CI 21.16-43.47% at an average of 13.8 years after surgery. Among patients with significant degenerative disc changes, the SRS-22 functional, self-image, and satisfaction domains showed significantly worse results (MD - 0.25, 95% CI - 0.44 to - 0.05; MD - 0.50, 95% CI - 0.75 to - 0.25; and MD - 0.34, 95% CI - 0.66 to - 0.03, respectively). Furthermore, instrumentation at or above the L3 level was associated with a lower incidence of intervertebral disc degeneration compared to instrumentation below the L3 level (OR 0.25, 95% CI 0.10-0.64). It was also found that the preoperative and final follow-up lumbar curve magnitudes (MD 8.11, 95% CI 3.82-12.41) as well as preoperative and final follow-up lumbar lordosis (MD 0.42, 95% CI - 3.81 to 4.65) were associated with adjacent disc degeneration. CONCLUSIONS This meta-analysis demonstrated that the incidence of intervertebral disc degeneration significantly increased with long-term follow-up using fusion techniques, reaching up to 32% when patients were 28 years of age. Incomplete correction of deformity and fusion of levels below L3, were identified as negative prognostic factors. Furthermore, patients with disc degeneration showed worse functional outcomes.
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Affiliation(s)
| | - Eduardo Hevia
- Spine Unit, University of Navarra Clinic, Madrid, Spain
| | | | - Vicente García
- Spine Surgery Section, Araba University Hospital, Vitoria, Spain
| | | | - Gonzalo Mariscal
- Mediterranean Observatory for Clinical and Health Research (OMEDICS), Valencia, Spain.
- Institute for Research On Musculoskeletal Disorders, Valencia Catholic University, Carrer de Quevedo, 2, 46001, València, Valencia, Spain.
| | - Carlos Barrios
- Institute for Research On Musculoskeletal Disorders, Valencia Catholic University, Carrer de Quevedo, 2, 46001, València, Valencia, Spain
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Souza AFMD, Avila LM, Aguiar CAD, Rocha LEMD. PRE- AND POSTOPERATIVE COMPARATIVE ANALYSIS OF THE SPINOPELVIC AND GLOBAL SAGITTAL PARAMETERS OF PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222101250514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To analyze the pre- and postoperative spinopelvic parameters and global sagittal balance of patients with adolescent idiopathic scoliosis (AIS) divided into 3 groups (Group 1 – thoracic arthrodesis, Group 2 - thoracolumbar arthrodesis, and Group 3 – lumbar arthrodesis), observing differences in these two moments and whether the parameter values are maintained or not over a period of up to 2 years following surgery. Methods: We analyzed the radiographs from a single-center database of 99 patients who underwent arthrodesis with posterior instrumentation. Pelvic incidence, pelvic version, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis values were measured in the pre- and postoperative radiographies of each patient. Results: The parameters of pelvic incidence, pelvic version, sacral slope, and sagittal vertical axis did not show statistically significant differences among the 3 groups. There was a difference in preoperative lumbar lordosis between the 3 groups (p = 0.049). Thoracic kyphosis showed differences both in the pre- (p = 0.015) and postoperative (p = 0.042) values, in addition to demonstrating a relationship of dependence between the pre- and postoperative values in the final statistical analysis. Conclusion: The evaluation of the parameters analyzed shows that the study groups have similar values of individual balance, with the exception of thoracic kyphosis and lumbar lordosis, which are measurements that depend on the surgical technique and compensatory mechanisms, but remained within normal ranges. These factors allow the surgeon to be attentive to both the coronal and sagittal planes when planning the correction in order to achieve the equilibrium of the trunk in addition to correction of the deformity. Level of Evidence IIIA: Comparative retrospective study.
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Youn YH, Cho KJ, Na Y, Kim JS. Global Sagittal Alignment and Clinical Outcomes after 1-3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases. Asian Spine J 2021; 16:551-559. [PMID: 34551501 PMCID: PMC9441428 DOI: 10.31616/asj.2021.0182] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design Level III retrospective study. Purpose We investigated the impact of short-segment lumbar fusion on the restoration of global sagittal alignment and the correlations between spino-pelvic parameters and clinical outcomes. Overview of Literature Sagittal imbalance leads to energy consumption and pain in maintaining a standing position. For adult spinal deformity, it is critical to create optimal lumbar lordosis (LL) in order to achieve restoration of sagittal imbalance. However, surgeons do not pay attention to correcting LL in short-segment lumbar fusion. Methods A total of 69 patients with transforaminal lumbar interbody fusion (TLIF) for degenerative spinal disease were evaluated with a minimum 2-year follow-up. All patients underwent TLIF with hyper-lordotic angle cages to achieve higher LL. Radiological spino-pelvic parameters including sagittal vertical axis (SVA) and clinical outcomes using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were evaluated. Results The average LL was 35.8°±9.9° before surgery, 42.3°±9.3° 1 year after surgery, and 40.3°±10.2° 2 years after surgery (p <0.01). The average SVA was 43.1±6.2 mm before surgery, 21.2±4.9 mm 1 year after surgery, and 34.0±4.7 mm 2 years after surgery (p <0.01). The average LL and SVA improved in two- or three-segment fusion, but not in one-segment fusion. The correlation between ΔLL and ΔSVA was significant in all segment fusions. The correlation between ΔLL and ΔSVA was more significant at the L4-5 and L5-S1 segments than at L3-4. ODI was significantly correlated with SVA (p <0.05). NRS showed no correlation with the radiological parameters. Conclusions Two- or three-segment lumbar fusion using hyper-lordotic angle cages improved LL and SVA. A significant correlation between the correction of LL and SVA was found. Higher correction of LL using hyper-lordotic angle cages is thus recommended in short-segment lumbar fusion, since postoperative improvements of SVA significantly affect clinical outcomes.
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Affiliation(s)
- Yung-Hun Youn
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Kyu-Jung Cho
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yeop Na
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Jeong-Seok Kim
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
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Yang JH, Shin JW, Park SR, Kim SK, Park SJ, Min JH, Lee BH, Suk KS, Park JO, Moon SH, Lee HM, Kim HS. Transient fixation of L4 vertebra preserves lumbar motion and function in Lenke Type 5C and 6C scoliosis. Sci Rep 2021; 11:10192. [PMID: 33986432 PMCID: PMC8119700 DOI: 10.1038/s41598-021-89674-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/20/2021] [Indexed: 11/09/2022] Open
Abstract
This study investigated the efficacy of a novel surgical method that relies on the transient fixation of L4 in Lenke Type 5C and 6C adolescent idiopathic scoliosis. Thirty-six transient surgically treated L4 fixation patients were retrospectively evaluated. The first surgery involved mechanical correction of scoliosis; the lowest instrumented vertebra (LIV) was L4. After an average of 1.3 years (range, 0.3-3.4), the second surgery to remove transient L4 pedicle screws was performed. Radiographic parameters and SRS-22 scores were measured. Cobb's angle, coronal balance, LIV tilting angle, and LIV coronal disc angle clearly improved after the first surgery (p < 0.01). After the second surgery, the corrected Cobb angle (p = 0.446) and coronal balance were maintained (p = 0.271). Although L3/S1 lumbar lordosis decreased after the first surgery (p < 0.01), after removal of transient L4 pedicle screws, it recovered slightly (p = 0.03). Similarly, the preoperative L3/4 lateral disc mobility eventually recovered after transient L4 screw removal (p < 0.01). The function domain of the SRS-22 showed better scores after removal of transient L4 screws (p = 0.04). L4 transient fixation surgery is beneficial for Lenke Type 5C and 6C scolioses that do not fully satisfy LIV (L3) criteria. It preserves L3/4 disc motion, increases functional outcomes, and maintains spinal correction and coronal balance.
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Affiliation(s)
- Jae-Ho Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jae-Won Shin
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sub-Ri Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sun-Kyu Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sang-Jun Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Ji-Hwan Min
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Byoung-Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kyung-Soo Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jin-Oh Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea. .,Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
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Impact of Spinal Deformity Characteristics on Patient-reported Outcome Measurement Information System Scores in Patients With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00009. [PMID: 33735148 DOI: 10.5435/jaaosglobal-d-21-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The impact of posterior spinal fusion (PSF) on physical function and pain and mental health in pediatric patients as quantified by the Patient-Reported Outcomes Measurement Information System (PROMIS), developed by the National Institute of Health, is largely unknown. The purpose of this study is to report the changes of PROMIS scores for upper extremity (UE), pain interference (PI), mobility (MOB), and peer relationships (PR) after PSF in patients with idiopathic scoliosis (IS), compare postoperative changes in PROMIS PI and Scoliosis Research Society-30 pain scores, and evaluate associations between curve characteristics and PROMIS scores. METHODS A retrospective cohort of 122 patients (<18 years old) who underwent PSF for IS was identified through electronic medical record search. PROMIS scores were obtained preoperatively and 6 weeks, 6 months, 1 years, 2 years, and 3 years postoperatively. RESULTS The mean age of the cohort was 14.2 ± 1.6 years, and the mean Cobb angle was 62.9 ± 13.8° at surgery. Eighty patients had preoperative PROMIS data. UE and MOB scores were statistically lower at 6 weeks and 6 months postoperatively and returned to baseline with a longer follow-up. PI scores were significantly lower at 1 and 2 years postoperatively. PR was unchanged up to 2 years postoperatively and then showed significant improvement. There was a statistically significant negative relationships between lowest instrumented vertebra and PROMIS UE and MOB scores at 6 weeks and 1 year postoperatively, but not at a longer follow-up. There were no significant differences noted in PI and PR PROMIS scores and lowest instrumented vertebra. PROMIS scores were not statistically associated with the Lenke Classification, number of vertebral levels fused, or percentage coronal correction. DISCUSSION Changes in PROMIS functional domains (UE and MOB) postoperatively normalize at longer follow-ups. Changes in PI and PR demonstrated improvements over preoperative values at 1 to 2 years postoperatively. Preoperative coronal and sagittal measures, and the percentage correction did not correlate with any PROMIS scores.
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Importance of lowest instrumented vertebra on clinical and radiological outcomes in patients with Lenke type 3C adolescent idiopathic scoliosis: a minimum 4-year follow-up. J Pediatr Orthop B 2020; 29:580-589. [PMID: 31856040 DOI: 10.1097/bpb.0000000000000696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The purpose of this retrospective study was to determine the most appropriate distal fusion level in terms of clinical results and radiological changes in Lenke 3C adolescent idiopathic scoliosis (AIS). Between June 2010 and May 2014, a total of 90 consecutive patients who underwent surgery for Lenke 3C AIS were divided into three groups as L2, L3, and L4 according to the fusion levels and compared in terms of functional and radiological outcomes. Patients were evaluated with Scoliosis Research Society 22 (SRS 22) and the Oswestry disability index (ODI) at the final follow-up. Preoperative standard posteroanterior and lateral whole-spine radiographs and lateral bending radiographs were used to evaluate the curves. All patients were also assessed with lumbar MRI at the final follow-up, and classified for each patient in terms of disc degeneration (DD) and facet joint degeneration (FJD). There was a statistically significant difference between the groups in terms of ODI category (P = 0.001). The rate of minimal disability in the L3 group, moderate disability in the L2 group, and severe disability in the L4 group were higher. Statistically significant differences were observed between the groups in terms of pain, body image, mental health, and total score distribution from the SRS-22 domains (P < 0.05). No significant difference was observed between the groups in terms of DD and FJD in MRI (P = 0.263). Although the preoperative functional scores could not be evaluated due to the retrospective nature of the study, it was observed that the only significant difference between the groups was the SRS-22 score. The best SRS-22 score was obtained in patients in whom fusion was stopped at L3.
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