Congenital thoracic scoliosis with unilateral unsegmented bar, convex hemivertebrae, and fused concave ribs with severe progression after posterior fusion at age 2: 40-year follow-up after revision anterior and posterior surgery at age 8.

STUDY DESIGN: Case report with 40-year follow-up after definitive surgery. OBJECTIVE: To show that extensive spine fusion in a young child can control the curve and does not necessarily lead to early death. SUMMARY OF BACKGROUND DATA: Recent efforts to avoid early spine fusion by using either progressive lengthening of spinal or rib cage implants are based on the theory that early spine fusion is deleterious and results in early death due to pulmonary compromise. Unfortunately, there is little to no documentation to support this theory. METHODS: This is a single case report of a child who at the age of 3 months had a 32° congenital thoracic congenital scoliosis with a unilateral unsegmented bar, concave fused ribs, and convex hemivertebrae. By age 2 years, the curve had progressed to 64°, so a posterior fusion was done from T5 to T12. By age 8 years, the curve had dramatically increased, and she was referred to the author. She underwent a double-wedge osteotomy, both anteriorly and posteriorly, plus anterior fusion T4-L3 and posterior fusion from T1 to L3. A halo cast was used for correction. RESULTS: At a 40-year follow-up after her definitive surgery at the age of 8 years, she is still alive and functioning well, although her vital capacity is poor. CONCLUSION: Extensive thoracic spine fusion at an early age did not result in early death, but the patient is far from ideal.

L5 hemivertebra resection and T12-S1 fusion in a 14-year-old female with a 36-year follow-up.

STUDY DESIGN: Case report. OBJECTIVE: To demonstrate a 36-year follow-up of a rare operation. SUMMARY OF BACKGROUND DATA: There have been no reports of follow-up of pediatric hemivertebra excision and fusion into midadult life. METHODS: A chart and radiological review at 36 years after surgery. RESULTS: The patient is alive and well and leading a normal life. Her Oswestry Disability Index is 0. Mild degenerative radiological signs are evident at the adjacent level above (T10-T12) and below (sacroiliac joints). CONCLUSION: Early excision of the L5 hemivertebra would have been preferable, but the long-term results are good.

Severe neurofibromatosis kyphoscoliosis, posterior wedge osteotomy, halo-traction, and anterior autograft strut fusion, with 28-year follow-up.

STUDY DESIGN: Case report with very long-term follow-up. OBJECTIVE: To demonstrate the lasting value of correction and stabilization with multiple anterior autogenous strut grafting. SUMMARY OF BACKGROUND DATA: Although anterior strut grafting has been shown to be ideal for neurofibromatosis kyphosis, there have been no reports as to whether the benefit is maintained or lost over many years. METHODS: This is a single case report with very long-term follow-up. RESULTS: This adult patient, operated in February 1982, has been followed for 28 years, and is doing very well in life, although her pulmonary capacity is compromised. CONCLUSION: Although patients with severe spine deformity because of neurofibromatosis tend to deteriorate with time, this patient demonstrates that with aggressive correction and fusion management, a long-term good quality of life can be achieved.

Effect of number of fusion levels on S1 screws in long fusion construct in a calf spine model.

STUDY DESIGN: In vitro biomechanical study evaluating the effect of fusion levels on simulated S1 screws on calf spines. OBJECTIVE: To measure the stresses of simulated S1 screws as a function of increasing fusion levels in long-fusion construct. SUMMARY OF BACKGROUND DATA: Extension of long fusion to sacrum remains a difficult clinical challenge despite the recent knowledge and technology. Several biomechanical studies have evaluated the bending moment on sacral screw of various fixation techniques. The high risk of sacral screw failure has been primarily attributed to the long lever arm of instrumentation and pullout force on S1 screw. However, none of these studies characterized how the number of fusion levels affected the sacral screw stresses. Because the number of fusion levels is an important factor in considering additional fixation options to protect the sacral screws, the effect of fusion levels on sacral screw stresses must be understood. METHODS: Eight calf spines (T13-L5) were used in this study (L5 is simulated as S1). Twelve pedicle screws were inserted. A combination of strain gages were attached to the spinal rods located between L4 and L5. Pure flexion moment (7.5 Nm) was applied to the partially fused construct as the level of fusion varied between 1 and 5 levels. The number of fusion levels increased from lower vertebrae to upper vertebrae. The pullout force, bending moment, and transverse force acting on the S1 screw were calculated from the strain gage signals. One way repeated measure ANOVA was used to analyze the pullout force, bending moment, and transverse force data. RESULTS: The pullout force and transverse load had significant difference between single and multilevel fusion. However, no difference was found among multilevel fusion procedures (all P > 0.05). The mean pullout force was 29 ± 8 and mean transverse force was 139 ± 18 N. For bending moment, there was no statistical difference among all fusion levels. The average bending moment was 1.02 ± 0.34. Addition of anterior interbody cages at lower levels (L3-L4 and L4-L5) reduced the stresses on the simulated S1 screw by approximately 20% with P < 0.05. CONCLUSION: All three stresses, flexion moment, transverse load, and screw pullout force, must be considered in studying the biomechanics of long-fusion construct. There was no significant increase in sacral screw loading with increasing fusion levels when the same flexion moment was applied. It is postulated that the higher load present in long-fusion construct may lead to the premature failure of the lumbosacral fixation.

Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy.

STUDY DESIGN: A retrospective clinical cohort study at a single spine center of patients with degenerative scoliosis and radiculopathy severe enough to require surgery. OBJECTIVE: To evaluate the functional outcomes of 3 surgeries for degenerative scoliosis with radiculopathy; decompression alone, decompression and limited fusion, and decompression and full curve fusion. SUMMARY OF BACKGROUND DATA: Although these 3 surgical treatments have all been described for this problem, there exists little information as to what outcomes to expect. METHODS: The study cohort consisted of 85 patients who met the inclusion criteria of degenerative scoliosis and radiculopathy, who had undergone 1 of the above 3 surgeries, who had not had any previous lumbar spine surgery, who had a minimum follow-up of at least 2 years, and who had filled out preoperative and postoperative functional evaluation forms including SF-36, Oswestry Disability Index, Roland Morris Scores, and a satisfaction questionnaire. Logistic regression analysis was conducted to predict the likelihood of success as related to decompression alone of rotatory olisthetic segments, extent of fusion, and postoperative sagittal balance. Patient demographics including curve magnitude, operative blood loss, length of hospital stay, complications, and need for revision surgeries were analyzed. The patients having decompression alone had the highest mean age (76.4 years) compared to decompression and limited fusion (70.4), and decompression and full curve fusion (62.5). RESULTS: Cobb scoliosis angles remained unchanged in the 2 groups not having full curve fusion, while the full curve fusion group changed from a mean 39° before surgery to 19° at follow-up. The complication rate was highest (56%) in the full fusion group, was 40% in the limited fusion group, and 10% in the decompression alone group. The overall SF-36 analysis showed significant improvement in bodily pain, social function, role emotional, mental health, and mental composite domains. Oswestry Disability Indexes improved significantly in the decompression alone and limited fusion groups, but not in the full fusion group. In contrast, the satisfaction questionnaire showed the highest success to be in the full-curve fusion group and the lowest in the decompression-only group.Regression analysis revealed that sacrum to curve apex fusions and positive postoperative sagittal imbalance were associated with poor outcomes. CONCLUSION: Both good and poor results were seen with each of the 3 procedures.

The Moe Maximal Correction Test to determine true curve flexibility: a historical note with current application.

This is not a prospective randomized clinical trial or a consecutive case series, but rather the description of a technique developed years ago, but still applicable. As spine surgeons, we wish to know the true correctability of a curvature before determining the best method of treatment. Do we need to do a posterior surgery only? Do we need to do a combined anterior and posterior surgery? Do we need to place the patient in preoperative skeletal traction? Although many different techniques have been described for the determination of true curve flexibility, the Moe Maximal Correction Test has never before been described.

Development and growth of anterior spine surgery in Minnesota.

Until the 1960s, it was not possible to directly access the thoracic vertebrae in order to correct conditions such as congenital kyphosis. Attempts to treat problems using traditional posterior spine surgeries often failed, leaving patients paraplegic. Using a procedure initially done in Hong Kong, surgeons from the University of Minnesota in 1966 became some of the first in the United States to access the thoracic spine from the anterior position, allowing for correction of deformities. This article highlights Minnesota surgeons' contributions to the development of anterior spine surgery.

Scoliosis secondary to a hemivertebra: seven patients with gradual improvement without treatment.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To make clinicians aware of this unusual natural history. SUMMARY OF BACKGROUND DATA: Nonprogressive and progressive scolioses due to hemivertebrae have been abundantly documented in the literature. There has been no article describing spontaneous improvement. Two case reports have been described elsewhere in a general article on natural history. METHODS: From a previous review of 1250 patients with congenital spine deformity of all types, 7 patients were identified with spontaneous improvement of their scoliosis due to a hemivertebra during growth. RESULTS: The mean curve at start of observation was 31 degrees (range: 24 degrees -43 degrees), and at the end of observation was 19 degrees (range: 10 degrees -30 degrees). Six of the curves were at the thoracolumbar region (T11-L2), and the other at T1. The average duration of follow-up was 9 years. CONCLUSION: Spontaneous curve improvement is rare, but possible. In view of the difficulty of prediction for curves due to a hemivertebra, careful observation with careful curve measurement is recommended. Inappropriate early, aggressive surgery should be avoided.

Repeatability test of C7 plumb line and gravity line on asymptomatic volunteers using an optical measurement technique.

STUDY DESIGN: Prospective cohort evaluation of C7 plumb line (C7PL) and gravity line (GL) in different standing positions in asymptomatic volunteers. OBJECTIVE: To evaluate the repeatability of C7PL and GL in different standing positions using an optical method. SUMMARY OF BACKGROUND DATA: Both C7PL and GL have been used to assess spinal balance. However, due to extensive radiation exposure, the measurement repeatability for both C7PL and GL has never been systematically determined. METHODS: Thirty asymptomatic adult volunteers were enrolled in this study. Two optical markers were attached to the skin overlying the spinous processes of C7 and S1. Volunteers were instructed to stand on a force plate with their arms in 3 different positions, clavicle, supported, and neutral, for posteroanterior (PA), and lateral views. Digital photos were taken for 12 times for each position. The GL position was displayed on a computer in real time. The distance from the C7 marker to S1 marker (C7-S1) and the distance from the GL to the S1 marker (GL-S1) were measured in both PA and lateral views. The repeatability on a single subject was defined as the standard deviation of the 12 repeated measurements for each standing position. RESULTS: In the PA view, the repeatability of both C7PL and GL was 3 to 4 mm in all 3 standing positions (all P > 0.05). In the lateral view, the repeatability of C7PL increased from 6 to 8 mm whereas GL remained low at 3 to 4 mm. The GL repeatability was significantly better than that of C7PL in all 3 lateral positions (all P < 0.05). The standing position did not significantly affect repeatability for both C7PL and GL. C7PL had approximately 1-cm posterior shift in the supported position and 2-cm posterior shift in the clavicle position. The effect of various radiographic positions was less than 1 cm for all 3 standing positions in the GL measurement. CONCLUSION: The GL measurement was highly reproducible in both PA and lateral views. The repeatability was similar between C7PL and GL despite the standing positions in the PA view. The repeatability of GL was better than that of C7PL in all 3 standing positions in the lateral view. The effect of standing positions was much less in GL than in C7PL.

Long-term follow-up of adolescent idiopathic scoliosis patients who had Harrington instrumentation and fusion to the lower lumbar vertebrae: is low back pain a problem?

STUDY DESIGN: Retrospective functional and radiographic analysis. OBJECTIVE: To analyze the back pain and disability in patients who had instrumentation and fusion to L2, L3, L4, or L5, at least 10 years previously, and to compare them with a control group of the same age, sex, weight, and height. SUMMARY OF BACKGROUND DATA: Considerable confusion exists as to the incidence and severity of low back problems in patients with adolescent idiopathic scoliosis fused to the lower lumbar spine. MATERIALS AND METHODS: A total of 171 patients met the inclusion criteria of adolescent idiopathic scoliosis, Harrington instrumentation, and fusion to L2, L3, L4, or L5, a minimum follow-up of 10 years following surgery, and a detailed questionnaire at follow-up. These were compared to a control group of 209 persons of equal sex, age, weight, and height. Eighty-eight patients were personally evaluated, including radiographs at follow-up. The mean follow-up was 19 years. RESULTS: Back pain, no matter how trivial or infrequent, was noted in 75% of the patients and 65% of the controls, statistically different at P=0.039. Pain intensity was equal to controls in fusions to L2 or L3, but increased in those fused to L4. Comparing all fused patients to the controls, there was no difference in narcotic use, use of back supports, visits to physicians, or hospitalizations for back problems. There was no difference in the short form-36 in the patients according to whether fused to L2, L3, or L4. CONCLUSION: When compared to a control group of equal sex, age, weight, and height, adolescent idiopathic scoliosis patients had a slightly higher incidence of back pain. When compared to the control group using short form-36 evaluation, the patients had statistically equal scores in all 8 domains. Most patients were able to perform most activities of daily living.

Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up.

STUDY DESIGN: Retrospective case review at a single center. OBJECTIVE: To analyze the incidence and risk factors associated with proximal junctional kyphosis (PJK) and distal junctional kyphosis (DJK) in patients undergoing instrumented spinal fusion for Scheuermann kyphosis. SUMMARY OF BACKGROUND DATA: Previously reported risk factors for junctional kyphosis include improper end vertebrae selection, curve correction greater than 50%, or excessive junctional soft tissue dissection. METHODS: Clinical and radiographic data on 67 patients (mean age 37) from a single center treated with instrumented fusion for Scheuermann kyphosis were reviewed. All patients had complete radiographic data with a minimum 5-year follow-up (mean: 73 months). Abnormal PJK was defined by a proximal junctional angle greater than 10 degrees and at least 10 degrees greater than the corresponding preoperative measurement. DJK was similarly defined between the caudal endplate of the lower instrumented vertebra to the caudal endplate that was 1 vertebra below. RESULTS: The incidence of PJK as defined above was seen in 20 patients (30%). The development of PJK was associated with failure to incorporate the proximal end vertebra (15 patients), disruption of junctional ligamentum flavum (3 patients), or combination of both (2 patients). The most common cause of inappropriate end vertebra selection was poor visualization of the upper thoracic vertebra.DJK occurred in 8 patients (12%) and 7 of them had fusion short of including the first lordotic disc. CONCLUSION: The incidence of PJK can be minimized by the appropriate selection of the upper end vertebra to be fused and avoiding disruption of the junctional ligamentum flavum. The development of DJK can be minimized by incorporation of the first lordotic disc into the fusion construct.

Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis?

STUDY DESIGN: This study prospectively evaluated the health related quality of life (HRQOL) of 73 adults presenting with scoliosis at a single institution, as related to their spinal (C7 plumbline) and global (gravity line) balance. OBJECTIVE: To assess the influence of sagittal and coronal balance on HRQOL in adult scoliosis. SUMMARY OF BACKGROUND DATA: Many surgeons believe that achieving adequate spinal balance is important in the management of adult spinal deformity, but the evidence supporting this concept remains limited. A previous study has found weak correlations between sagittal spinal balance and HRQOL in adult spinal deformity, but this finding has never been confirmed independently. In addition, although the use of the gravity line is gaining interest in the evaluation of global balance, it remains unknown if this parameter is associated with HRQOL. METHODS: During a 1-year period, 73 consecutive new patients presenting with unoperated adult scoliosis and requiring full spine standing radiographs were evaluated using a force plate in order to simultaneously assess the gravity line. All patients also completed the Oswestry Disability Index (ODI) questionnaire to assess the HRQOL. Spinal balance was evaluated from the C7 plumbline and global balance from the gravity line, respectively. C7 plumbline and gravity line were both assessed with respect to the posterosuperior corner of the S1 vertebral body and central sacral vertebral line in the sagittal and coronal plane, respectively. C7 plumbline and gravity line, as well as their relative position, were correlated with the ODI, using Spearman coefficients. RESULTS: Sagittal spinal (C7 plumbline) and global (gravity line) balance, as well as their relative position were significantly related to the ODI. A poor ODI (>34) was associated with a sagittal C7 plumbline greater than 6 cm, a sagittal gravity line greater than 6 cm, and a C7 plumbline in front of the gravity line. Correlations between coronal balance and the ODI were not statistically significant. CONCLUSION: Sagittal spinal and global balance was strongly related to the ODI in adults with scoliosis. The observed correlation coefficients were higher than those reported in the only previous study suggesting the detrimental association of positive sagittal balance on ODI in adult spinal deformity. Coronal spinal and global balance did not influence the ODI in the current study cohort. Thisstudy underlines the relevance of C7 plumbline and gravity line in the evaluation of spinal and global balance, and lends further support to the philosophy of achieving adequate sagittal balance in the management of adult spinal deformity, especially in patients older than 50 years old with degenerative scoliosis.

A correlation of radiographic and functional measurements in adult degenerative scoliosis.

STUDY DESIGN: Retrospective functional and radiographic analysis of symptomatic patients with de novo degenerative lumbar and thoracolumbar scoliosis. OBJECTIVE: To evaluate the radiographic parameters of symptomatic patients presenting with de novo degenerative adult scoliosis and correlate them with functional scores. SUMMARY OF BACKGROUND DATA: Previous studies have been inconclusive as to the correlation of radiographic parameters and clinical symptomatology. METHODS: Radiographic analysis of 58 consecutive symptomatic patients with de novo degenerative lumbar and thoracolumbar scoliosis was performed using posteroanterior and lateral 36-inch standing radiographs. Measurements included curve type, curve location, curve magnitude, coronal alignment, sagittal alignment, and anteroposterior and lateral intervertebral olisthesis. Clinical functional data were measured with Oswestry Disability Index, Roland-Morris Disability Questionnaire, and RAND 36-item Health Survey questionnaire. Correlation between clinical data and radiographic data were then calculated. RESULTS: Sagittal balance did not show significant correlation with functional results. However, coronal imbalance (more than 5 cm from midsacrum) affected physical function (P = 0.028) and outcomes (P > 0.05). Also, moderate to severe lateral olisthesis (equal or more than 6 mm) demonstrated higher bodily pain then mild lateral olisthesis (P = 0.005). Good lumbar lordosis correlated positively with health assessment as reflected in SF-36 score (P = 0.039, r = 0.291). CONCLUSION: Reduced lumbar lordosis and increased lumbosacral scoliosis can affect the general health status of older patients with de novo degenerative scoliosis. Lateral olisthesis, mainly, and anteroposterior olisthesis are important elements of rotatory subluxation in the lumbar curves, which are important radiographic parameters, predicting symptomatology and health status of patients with de novo degenerative scoliosis.

Functional and radiological outcomes of 360 degrees fusion of three or more motion levels in the lumbar spine for degenerative disc disease.

STUDY DESIGN: This is a single-center, multisurgeon, retrospective study of radiologic and functional outcome measures at a minimum 2-year follow-up. OBJECTIVE: We studied the radiologic and functional outcomes following 3 or more motion segment fusions of the lumbar spine for low back pain due to multilevel degenerative disc disease. SUMMARY OF BACKGROUND DATA: Good functional outcomes have been reported for 1 or 2-level fusions, but there are no reports dealing specifically with 3 or more level fusions. METHODS: A total of 80 adult patients met the inclusion/exclusion criteria of multilevel (3 or more motion segments) 360 degrees fusion for lumbar degenerative disc disease, failed nonoperative treatment for at least 1 year, no previous lumbar fusion, no fracture, tumor or infection of the spine, completed preoperative and postoperative functional questionnaires including SF-36 (n = 80), Oswestry (n = 69), Roland Morris (n = 68), and radiologic evaluation of fusion solidity with a minimum follow-up of 2 years. RESULTS: The average patient age was 57 years (range, 27-81). The mean follow-up was 4 years (2-7). On average, patients had fusion of 4 motion segments (range, 3-8 levels). Solid arthrodesis at the first surgery was achieved in 65/80 (81%). Adjacent segment degeneration was noted in 11 patients. Of these, 5 had undergone an extension of their fusion within the study period. There were no deaths or neurologic complications. Deep wound infection occurred in 2 patients, neither requiring implant removal. The Oswestry Disability Index scores improved from 49.8 to 35.1 (29.5%) (P < 0.001). The Roland Morris scores improved from 17.6 to 12.2 (30.7%) (P < 0.001). For the SF-36 scales, significant (P < 0.001) improvement was seen in all scales except Role Emotional scores and Mental Composite Scales. CONCLUSION: The surgical treatment of lumbar degenerative disc disease by 360 degrees fusion should be considered for properly selected patients. The goal of surgery is reduction, not elimination of disability.

A concomitant posterior approach improves fusion rates but not overall reoperation rates in multilevel cervical fusion for spondylosis.

STUDY DESIGN: Retrospective comparative study of 2 approaches to multilevel fusion for cervical spondylosis in consecutive patients at a single institution. OBJECTIVE: To provide justification for a concomitant posterior approach in multilevel cervical fusion for spondylosis by demonstrating decreased pseudarthrosis and reoperation rates. SUMMARY OF BACKGROUND DATA: Among the factors that affect cervical rates is the number of levels, such that increasing the number of levels leads to lower fusion rates. Because of this, modifications have been sought to improve union in multilevel procedures. One option is an antero-posterior (AP) approach or circumferential arthrodesis. METHODS: Seventy-eight consecutive patients who underwent multilevel cervical fusion at a single institution and with minimum 2-year follow-up data were divided into an anterior-only group (anterior: n=55), and an AP group (AP: n=23). Union was assessed by surgical exploration, computerized tomography scan, and flexion-extension radiographs. The groups were compared in terms of pseudarthrosis rates and reoperation rates. RESULTS: Using chi(2) analysis, there was a significant difference in pseudarthrosis rates (anterior 38% vs. AP 0%; P<0.001), and reoperation rate for pseudarthrosis (anterior 22% vs. AP 0%; P=0.01). There were no differences in overall (anterior 36% vs. AP 30%; P=0.62) and early (anterior 15% vs. AP 26%; P=0.13) reoperation rates, but late reoperations were increased in the anterior group (24% vs. AP 4%; P=0.043). CONCLUSIONS: A concomitant posterior fusion significantly reduced the incidence of pseudarthrosis (0% vs. 38%) and pseudarthrosis-related reoperations (0% vs. 22%) compared with traditional anterior-only fusion. However, this did not translate to a difference in overall reoperation rates. The majority of reoperations in the AP group (86%) were performed within 6 months, whereas those in the anterior-only group (65%) were performed later, which was generally when a pseudarthrosis became evident.

Ultra-long-term follow-up of pediatric spinal deformity problems: 23 patients with a mean follow-up of 51 years.

BACKGROUND: The aim of this study was to analyze the true outcomes of a unique cohort of patients with spinal deformities who were treated as children and followed for 40 or more years. METHODS: Altogether, 23 patients were reviewed who had been originally treated in our community, whose original charts and radiographs were still available, and who had undergone recent evaluation. RESULTS: The diagnoses were congenital deformity in eight, adolescent idiopathic scoliosis in four, poliomyelitis in three, infantile idiopathic scoliosis in two, spondylolisthesis in two, and one each of tuberculosis and dwarfism. Sixteen had undergone fusion surgery. CONCLUSIONS: Early spine fusion for deformity produced far better results than delayed fusion. A solid fusion at the end of growth remained unchanged. Degenerative changes outside the fusion area were rare and seldom required further surgery. In summary, 23 patients with a mean follow-up of 51 years after treatment are presented. Early fusion was far superior to delayed or nonsurgical treatment.

Cervical degenerative index: a new quantitative radiographic scoring system for cervical spondylosis with interobserver and intraobserver reliability testing.

BACKGROUND: The lack of a widely available scoring system for cervical degenerative spondylosis encouraged the authors to establish and validate a systematic quantitative radiographic index. MATERIALS AND METHODS: This study included intraobserver and interobserver reliability testing among three reviewers with different years of experience. Each observer independently scored four cervical radiographs of 48 patients at separate intervals, and statistical analysis of the grading was performed. RESULTS: There was high intraobserver and interobserver reliability between the two experienced observers. There was fair reliability between the less experienced observer and the more experienced observers. CONCLUSIONS: The cervical degenerative index appears to be a reliable and reproducible radiographic assessment of cervical spondylosis. The index will have direct applicability for longitudinal study of cervical spondylosis and may be clinically relevant as well.

Cervical degenerative changes in idiopathic scoliosis patients who underwent long fusion to the sacrum as adults: incidence, severity, and evolution.

BACKGROUND: To date, there have been no published studies of the degenerative changes in the cervical spine in adult idiopathic scoliosis patients with thoracic and lumbar curves severe enough to require major reconstructive surgery. MATERIALS AND METHODS: The primary study group was 48 adult patients who had previously undergone a fusion from T10 or higher to the sacrum as an adult for idiopathic scoliosis. These were compared to 38 adults with unfused idiopathic scoliosis of 30 degrees -50 degrees and to 42 symptomatic adults presenting with cervical pain. Cervical degeneration was assessed using a new cervical degenerative index (CDI). RESULTS: The amount of degenerative change seen in the cervical spine in the long-fusion group was significantly higher at baseline (just prior to the fusion) than the two control populations and became much higher at a mean follow-up of 8.5 years. CONCLUSIONS: This unique subgroup of patients, those having fusion from the thoracic spine to the sacrum as adults for adolescent idiopathic scoliosis, had a high incidence and severity of degenerative changes in their cervical spine. Due to the presence of advanced cervical degenerative changes prior to the fusion, it is not possible to blame the fusion as the main cause for these findings. These changes are either related to the thoracic and lumbar deformities or are more likely due to this subgroup having a higher natural propensity for degenerative changes.