A Prospective RCT On Decompression-only And Decompression With Fusion For Degenerative Scoliosis

Objective:Whether fusion by internal fixation are necessary in operation for degenerative scoliosis remains controversial at present. The aim of this study was to evaluate the outcomes of decompression with and without fusion in the treatment of degenerative scoliosis by a prospective randomized study, which discussed both the pros and cons in treatment of degenerative scoliosis, and to provide the basis for the choice of operation.Methods:A total of 62 patients from November 2012 to February 2013 who underwent the decompression with and without fusion by internal fixation for the treatment of degenerative scoliosis were prospectively studied. In Group A (n=30 patients), the patients were treated with the undermining decompression without fusion. In group B (n=32 patients), the patients were treated with decompression with fusion by internal fixation. Intraoperative data collection included surgical procedural details, operative time, hospital stays, estimated blood loss, and surgical complications. The preoperative demographic data and the postoperative follow-up data, including age, sex, Cobb angle, ODI (Oswestry Disability Indexes), VAS (Visual Analogue Scale/Score), were also been compared in our study.Results:All of the two groups of patients obtained follow-up 15 to 24 months postoperative, with an average of 19 months. Cobb scoliosis angles changed significantly in the 2 groups (group A:pre-operation 17.54±4.35°, three months after operation 10.51±5.40°,and last follow-up 10.51±5.37°; group B:pre-operation 11.53±2.29°, three months after operation 4.69±3.31, and last follow-up 4.69±3.33°), while the Cobb angles correction rate was higher (59±28)% in the fusion group than (42±25)% in the decompression-only group. The difference between the Cobb scoliosis angles pre-operation of the two groups was not statistically significant (P>0.01), and the difference between the Cobb scoliosis angles three months after operation of the two groups was statistically significant (P<0.01), and the difference between the Cobb scoliosis angles of three months after operation and last follow-up in every group was not statistically significant (P>0.01). Oswestry Disability Indexes and Visual Analogue Scores improved significantly from pre-operation to three months after operation and from three months after operation to the last follow-up in the two groups(P<0.01). There were significant differences between the decompression-only and decompression with fusion treatment groups in operative blood loss (99.04±46.42ml and 381.65± 100.65ml), operative time (99.04±46.42 minutes and 192.28±39.69 minutes, respectively; p<0.01), hospital stays±(11.66±2.89 and 12.79±3.55 days, respectively; p<0.01), and surgical complications (P<0.01).Conclusions:Both of the decompression-only and decompression with fusion are safe and effective operation to degenerative scoliosis patients. The decompression-only has less trauma, shorter operative time, hospital stays and less complication, While the decompression with fusion has high Cobb angles correction rate. The decompression-only can effectively avoid the instability of the decompressed levels, and the decompression with fusion can protect the decompressed levels, which ensured the decompression sufficient.