Meric Enercan1, Sinan Kahraman2, Mutlu Cobanoglu3, Sinan Yilar4, Bahadir Huseyin Gokcen2, Selhan Karadereler5, Ayhan Mutlu6, Levent Onur Ulusoy6, Cagatay Ozturk2, Erden Erturer2, Elif Gebes5, Tunay Sanli5, Ahmet Alanay7, Azmi Hamzaoglu5. 1. Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No: 166 Sisli, 34381 Istanbul, Turkey. Electronic address: enercan@yahoo.com. 2. Department of Orthopaedics and Traumatology, Istanbul Bilim University Faculty of Medicine, Gayrettepe Mh., 34349 İstanbul, Turkey. 3. Department of Orthopaedics and Traumatology, Adnan Menderes University Faculty of Medicine, Merkez Kampusu Aytepe Mevkii, 09100 Aydin, Turkey. 4. Department of Orthopaedics and Traumatology, Erzurum Ataturk University Faculty of Medicine, Vani Efendi Mah.Yakutiye, 2540 Erzurum, Turkey. 5. Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No: 166 Sisli, 34381 Istanbul, Turkey. 6. Department of Radiology, Florence Nightingale Hospital, Göktürk Merkez Mh., Göktürk Cd. No:25/A Bl., 34077 Eyüp, İstanbul, Turkey. 7. Department of Orthopaedics and Traumatology, Acibadem University Faculty of Medicine, Kayisdagi Cd. No:32 34755 Atasehir Istanbul, Turkey.
Abstract
OBJECTIVES: To evaluate the long-term behavior of the lumbar curve in patients with adolescent idiopathic scoliosis treated with selective thoracic fusion and to assess the clinical and radiologic outcomes in this fusion group compared with an age- and gender-matched group. SUMMARY OF BACKGROUND DATA: Selective thoracic fusion for the treatment of adolescent idiopathic scoliosis (AIS) preserves lumbar motion segments but leaves a residual deformity. By avoiding fusion of the lumbar spine, a greater mobility may be preserved, which may be an advantage in long-term follow-up in terms of degenerative changes in unfused segments. METHODS: Group A included 25 AIS patients with mean a age of 23.8 years and a mean 11.4 years of follow-up. Group B included 30 age- and gender-matched subjects without any deformity. Preoperative, postoperative, and follow-up radiographs were reviewed. All patients had MRIs taken at the final follow-up in order to evaluate disc degeneration (DD) and facet joint degeneration (FJD) at the unfused lumbar spine. Clinical evaluation was done by using Scoliosis Research Society-22R, Oswestry Disability Index, and numerical rating scale. RESULTS: Sagittal and coronal balance and lowest instrumented vertebra disc angulation were stable over time. Mean grading of lumbar DD was 2.16 (2-4) in Group A and 1.86 (1-3) in Group B. Lumbar FJDs were 2.05 (1-4) in Group A and 1.60 (1-3) in Group B. There was significant difference between the two groups for DD except for the L4-L5 level (p = .26). FJD was significantly higher in the L1-L2 and L2-L3 levels (L1-L2, p = .002, L2-L3, p = .002) but not for the other levels. Outcome scores were similar without significant differences between the two groups (p > .05). CONCLUSION: Selective thoracic fusion provides satisfactory outcomes at more than 10 years of follow-up. Our study demonstrated a moderate increase in the rate of disc degeneration in the unfused segments. Facet joint degeneration was significant at the upper two levels adjacent to the lowest instrumented vertebra.
OBJECTIVES: To evaluate the long-term behavior of the lumbar curve in patients with adolescent idiopathic scoliosis treated with selective thoracic fusion and to assess the clinical and radiologic outcomes in this fusion group compared with an age- and gender-matched group. SUMMARY OF BACKGROUND DATA: Selective thoracic fusion for the treatment of adolescent idiopathic scoliosis (AIS) preserves lumbar motion segments but leaves a residual deformity. By avoiding fusion of the lumbar spine, a greater mobility may be preserved, which may be an advantage in long-term follow-up in terms of degenerative changes in unfused segments. METHODS: Group A included 25 AISpatients with mean a age of 23.8 years and a mean 11.4 years of follow-up. Group B included 30 age- and gender-matched subjects without any deformity. Preoperative, postoperative, and follow-up radiographs were reviewed. All patients had MRIs taken at the final follow-up in order to evaluate disc degeneration (DD) and facet joint degeneration (FJD) at the unfused lumbar spine. Clinical evaluation was done by using Scoliosis Research Society-22R, Oswestry Disability Index, and numerical rating scale. RESULTS: Sagittal and coronal balance and lowest instrumented vertebra disc angulation were stable over time. Mean grading of lumbar DD was 2.16 (2-4) in Group A and 1.86 (1-3) in Group B. Lumbar FJDs were 2.05 (1-4) in Group A and 1.60 (1-3) in Group B. There was significant difference between the two groups for DD except for the L4-L5 level (p = .26). FJD was significantly higher in the L1-L2 and L2-L3 levels (L1-L2, p = .002, L2-L3, p = .002) but not for the other levels. Outcome scores were similar without significant differences between the two groups (p > .05). CONCLUSION: Selective thoracic fusion provides satisfactory outcomes at more than 10 years of follow-up. Our study demonstrated a moderate increase in the rate of disc degeneration in the unfused segments. Facet joint degeneration was significant at the upper two levels adjacent to the lowest instrumented vertebra.
Authors: Federico Solla; Walid Lakhal; Christian Morin; Jerome Sales de Gauzy; Gaby Kreichati; Ibrahim Obeid; Stéphane Wolff; Joël Lechevallier; Henry F Parent; Jean-Luc Clément; Carlo M Bertoncelli Journal: Eur J Orthop Surg Traumatol Date: 2021-06-18