The Comparation And Analysis Of Posterior Decompression Associated With Long And Short Segment Fusion For Treating Degenerative Lumbar Scoliosis

ObjectiveThe paper aims to investigate the long-term efficacy(treatment effect) of posterior decompression with long and short segment instrumentation and fusion for degenerative lumbar scoliosis(DLS).And explore the selecton of short fusion versus long fusion for degenerative lumbar scoliosis. MethodsA retrospective analysis of two kinds of posterior decompression and internal fixation treatment on clinical and radiographic outcomes by 40 cases with degenerative scoliosis.The cases are divided into two groups according to the fixed segment range.Group A:posterior decompression and long-segment(5.6±1.5segment) fusion in 23 cases.Group B:posterior decompression and short-segment(2.8±0.9 segment) fusion in 17 cases.The lumbocrural pain 、lower limbs pain and activity function were evaluated by JOA and VAS scores.The Cobb’ s angles were measured to assess the lumbar scoliosis and kyphosis.At the same time record ODI scores.The clinical and radiographic outcomes, including surgery time, blooding and surgery complications were compared between two groups. ResultsThe mean follow-up was 4 years( 2.5-6.5) for all patients, The blooding and surgery time of long-segment fusion group was significantly more than that of short-segment fusion group( P<0. 05).Before surgery,the average scoliosis Cobb angle was(27.5±7.2)°in the long-segment fusion group A and(19.5±4.6)°in the short-segment fusion group B,respectively,at the last follow up was(9.7±4.2)°in the long-segment fusion group A and(11±3.9)°in the short-segment fusion group B,The recovery rate of long fusion group was better than that of short fusion group( P < 0. 05).The lumbar lordosis angles before the operative was(17.8±9.7)°(group A) and(20.2±10.8)°(group B), and improved to 29±3.8°(group A) and 32±5.9°(group B) at final follow-up. The correction rate of two treatment groups had no significant difference( P = 0. 35). The ODI scores before the operative was(71.3±14.3)in the long-segment fusion group A and(64.2±20.7)in the short-segment fusion group B,at the last follow up was(48.7±17.1)in the long-segment fusion group A and(46.5±26.1)in the short-segment fusion group B, The improve rate of two treatment groups had no difference( P = 0. 17). The JOA scores of the preoperative and last fellow-up was 13±3.6、20±4.9(long-segment fusion group A) and 15±3.7、22±4.2(short-segment fusion group B)respectively, and both of two treatment groups improved after surgery. The improve rate of two groups have no difference(P=0.24).The VAS scores was improved from 8±1.7 to 3±2.7 in the long-segment fusion group A and 7±0.4 to 3±0.8 in the short-segment fusion group B,both treatment groups have significant improvement,The improve rate of two groups have no difference(P=0.21). ConclusionBoth long and short segmental fixation an fusion in the treatment of degenerative lumbar scoliosis can achieve good curative effect,Although the scoliosis correction rate of the long-segment fixation and fusion group is higher than the short-segment fixation and fusion group,but long-segment fixation and fusion causes a higher complication rate and increased surgery time and blooding.So,in the choice of surgical approach should rigorous analysis the clinical and radiographic outcomes, then make reasonable operation strategy.