Comparable rates of lumbar disc degeneration at long-term following adolescent idiopathic scoliosis spinal fusion extended to L3 or L4: systematic review and meta-analysis.
Spine Deform
; 12(4): 877-901, 2024 Jul.
Article
in En
| MEDLINE
| ID: mdl-38546965
ABSTRACT
PURPOSE:
Surgical treatment of adolescent idiopathic scoliosis (AIS) requires a careful choice of fusion levels. The usual recommendation for the selection of the lowest instrumented vertebra (LIV) for double major or thoracolumbar/lumbar (TL/L) curves falls on L3 or L4. The aim of the present study is to assess if the spinal fusion with LIV selection of L3 or L4 in AIS patients has a clinical or radiological impact in terms of degenerative disc disease (DDD) in distal unfused segments at long-term follow-up.METHODS:
A systematic search of electronic databases from eligible articles was conducted. Only studies regarding long-term follow-up of AIS patients treated with spinal fusion were included. Clinical and radiographic outcomes were extracted and summarized. Meta-analysis on long-term follow-up MRI studies was performed. p value < 0.05 was considered significant.RESULTS:
Fourteen studies were included, for a total of 1264 patients. Clinical assessment of included patients showed a slight tendency to have worse clinical outcomes if spinal fusion is extended to L4 rather than L3. Despite that, meta-analysis could not be performed on clinical parameters because of heterogeneity of evaluated PROMs in included studies. Magnetic resonance imaging (MRI) evaluation at long-term follow-up showed no significant difference in terms of disc degeneration rate at overall meta-analysis (p = 0.916) between patients fused to L3 and L4.CONCLUSION:
The LIV selection of L3 rather than L4, according to current literature, does not prevent disc degeneration in distal unfused segments over the long term. Long-term studies of patients treated with contemporary spinal instrumentation are needed.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Scoliosis
/
Spinal Fusion
/
Intervertebral Disc Degeneration
/
Lumbar Vertebrae
Limits:
Adolescent
/
Humans
Language:
En
Journal:
Spine Deform
Year:
2024
Document type:
Article
Affiliation country:
Italia
Publication country:
ENGLAND
/
ESCOCIA
/
GB
/
GREAT BRITAIN
/
INGLATERRA
/
REINO UNIDO
/
SCOTLAND
/
UK
/
UNITED KINGDOM