| Objective(s):Compare the curative effect of posterior long-segment(n?3)or short-segment(n<3)fixation in patients with Lenke-Silva level ? and above of adult degenerative scoliosis,analysis of preoperative,postoperative,and final follow-up symptoms,imaging parameters and complications,explore the different characteristics of the two treatments for similar patients,and provide reference for clinical decision-making.Method(s):This study retrospectively analyzed 35 patients with adult degenerative scoliosis who underwent surgical treatment of Lenke-Silva ? level and above in the Department of Orthopaedics,Second Affiliated Hospital of Kunming Medical University from January 2011 to September 2018,including 12 males(34.3%),23 women(65.7%).According to the specific circumstances of the patient,long segmental(n?3)or short segment(n<3)posterior fixation was operated,including 18 cases of long segment(51.4%)with posterior pedicle screw fixation,spinal deformity orthopedic(selection of osteotomy according to deformity),responsible segmental decompression and interbody fusion,laminectomy.Short segment 17 cases(48.6%)with posterior pedicle screw fixation,responsible segment decompression and interbody fusion.The preoperative,intraoperative and postoperative data were collected,and also collect the follow-up data of 3 months postoperative,6 months postoperative and every year postoperative.Statistics preoperative,postoperative and last follow-up(?6 months)data,analysis and compare.The curative effect was evaluated by visual analog scale(VAS)of low back pain and leg pain(numbness);imaging parameters was evaluated by coronal Coob angle,distance between C7 plumb line(C7PL)and center sacral vertical line(CSVL),sagittal lumbar lordosis(LL),sagittal vertical axis(SVA)and its differences between preoperative,postoperative and last follow-up,recording the intraoperative blood loss,operation time and postoperative complications.Statistical analysis was performed using SPSS 23,and the measurement data was expressed by the mean and standard deviation(x±s).For the independent samples of the same comparison index between the two groups,the independent sample t test was used to verify the hypothesis;for the relevant samples in the group,paired t-test was used to verify the hypothesis,for the count data,using the chi-square test.The difference of P<0.05 was statistically significant.Results:Results:1.Comparison between groups.18 patients(51.4%)in the long-segment group,6 males and 12 females,with an average age of(58.16±9.45)years,mean segments(7.44±1.82),and 7 complications occurred during follow-up;short-segment group 17 patients(48.6%),6 males and 11 females,with an average age of(66.59±7.64)years,mean segments(1.47±0.62),and 3 complications occurred during follow-up.There were no statistically significant differences between the two groups in sex(P=0.906)and number of complications(P=0.342).There were significant differences between the groups in age(P=0.007)and number of segments(P=0.000).Operation time:long-segment group(551.39±183.33)minutes,which was longer than the short-segment group(333.24±142.23)minutes,and the difference was statistically significant(P=0.004).Intraoperative blood loss:long segment group(1423.53±963.90)ml,lager than the short segment group(602.94±459.10)ml,the difference was statistically significant(P=0.000).The VAS score of low back pain(last follow-up):the long-segment group was lower than the preoperative(5.23±1.15),which was greater than the short-segment group(2.47±1.01),and the difference was statistically significant(P=0.000).The VAS score of leg pain(numbness)(last follow-up):The long-segment group reduce(3.65±1.62)points,which was smaller than the short-segment group(3.82±1.70),and the difference was not statistically significant(P=0.759).Complications:7 cases in the long-segment group(including 1 case of death caused by cerebrospinal fluid leakage and deep wound infection;1 case of shallow wound infection,poor wound healing;1 case of pulmonary infection;2 cases of pulmonary embolism;1 case of postoperative delirium;1 case of implants broken),more than 3 cases of short-segment group(including 1 case of screw canal repair,2 case of adjacent segment degeneration),the difference was not statistically significant(P=0.121).Imaging parameters:There were no significant differences between the preoperative coronal cobb angle,lumbar lordosis angle,C7PL-CSVL and SVA(P>0.05).Coronal Cobb correction was performed in the long-segment group(22.41±7.62)°,which was greater than that in the short-segment group(14.00±6.32)°.The difference was statistically significant(P=0.001).The last follow-up was also compared with postoperative,the mean change of the long-segment group(2.47±1.74)°was less than that of the short segment group(3.53±1.81)°,and the difference was not statistically significant(P=0.09).Coronal balance(C7PL-CSVL),long-segment group reduces(0.79±1.08)cm postoperative,less than(1.32±2.22)cm in short segment group,the difference was not statistically significant(P=0.383);last follow-up compared with postoperative,the mean change in the long-segment group was(0.47±0.78)cm,which was smaller than that in the short-segment group(0.65±0.58)cm,the difference was not statistically significant(P=0.460).Sagittal lumbar lordosis correction,the long-segment group corrects(14.53±11.98)°,greater than the short-segment group(9.94±8.11)°,the difference was statistically significant(P=0.20);the last follow-up compared with postoperative,the mean change of the long-segment group(3.29°2.44)°,was smaller than that of the short segment group(3.41±2.79)°,and the difference was not statistically significant(P=0.897).Sagittal balance(SVA),the long segment group mean corrects(1.53±1.69)cm,less than the short segment(1.91±1.75)cm,the difference was not statistically significant(P=0.522);the last follow-up compare to postoperative,long-segmental group changes(0.47±0.65)cm,short segment group changes(0.32±0.53)cm,the difference was not statistically significant(P=0.474).2.Comparison within long-segment groups.There is no statistically significant difference between the coronal and sagittal plane balance at the postoperative and last follow-up(P=1.000).Coronal Cobb angle,sagittal LL angle in preoperative and postoperative,preoperative and last follow-up,have significant differences(P<0.05).3.Comparison within short-segment groups.Similar to the long-segment group,there was no significant difference between the coronal and sagittal planes balance between the postoperative and last follow-up(coronal balance:P=0.787;sagittal balance:P=0.859),the other indicators are statistically significant(P<0.05).Conclusion(s):1.Surgical treatment is significantly effective for ADS.2.For ADS patients with Lenke-Silva level III and above,short-segment fixation has a short operation time and a small amount of bleeding,and has a certain degree of improvement in Cobb,LL,coronal and sagittal balance,and long-term follow-up,the improvement is not lost.The requirement of patient's surgical tolerance is low,and there are relatively few serious complications in the near future.3.Long-segmental fixation is better than short-segmental fixation in reducing low back pain,and its orthopedic effect is also better than short-segment fixation.However,there was no significant difference in the long-term orthopedic effect change between two groups.4.For these patients,the symptoms and complications should be evaluated,and individualized operation scheme should be draw up to reduce the risk of surgery and maximize the benefits for patients 5.Behind the changes in imaging parameters,there are multiple factors interaction such as the degenerative of the responsible segment,the compensatory function of the spine and the posture avoidance of the body.So more observation and research are still needed. |
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