[Clinical effects of different methods of the proximal fusion for long segmental lumbar vertebrae fusion in treatment of degenerative lumbar scoliosis].

ABSTRACT

Objective: To explored the clinical effects of different methods of the proximal fusion for long segmental lumbar vertebrae fusion in treatment of degenerative lumbar scoliosis(DLS). Methods: From January 2007 to March 2014 fifty-five cases of DLS treated by the posterior proximal fusion of long segmental lumbar vertebrae fusion were analyzed in Department of Orthopaedics, Shanghai general Hospital of Nanjing Medical University (35)HuaiAn The First Hospital Affiliated to Nanjing Medical University(20). According to various upper instrumented vertebra(UIV) the patients were divided into Group A(upper horizontal vertebra, UHV, n=17), Group B (upper natural vertebra, UNV n=18 ), and Group C(upper end vertebra, UEV, n=20). The VAS, ODI, spinal balance parameters and postoperative complications in each group were assessed. Results: Except for 1 case death of serious lung infection in early postoperative, 54 cases were received 2-4 years follow-up. No statistical differences in improvements and fusion rates were found among 3 groups (P>0.05). The improvements of the coronal Cobb's angle in the A group were significantly more than the C group (75.8%±12.8%, 69.6%±11.8%, 63.4%±15.3%, P<0.05). The incidences of early postoperative complications in A group were the highest, next in B group, and lowest C group (52.9%, 22.0%, 15.0%, P<0.05). The incidences of proximal ASD in the C group were significantly more than the A group (12.5%, 22.2%, 50.0%, P=0.045). Conclusion: UHV, UNV and UEV had similar clinical outcomes for treatment of degenerative lumbar scoliosis in short term. Correction of the coronal deformity of UHV was superior to UEV. UEV was beneficial to reduce early complications, but more likely to happen proximal adjacent segment degeneration in the long run.