Spine Surgery Department, Istituti Ortopedici Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
Spine Surgery Department, Istituti Ortopedici Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
Spine J. 2014 Jan;14(1):1-10. doi: 10.1016/j.spinee.2012.10.023. Epub 2012 Dec 17.
Posterolateral fusion with pedicle screw instrumentation is currently the most widely accepted technique for degenerative lumbar scoliosis in elderly patients. However, a high incidence of complications has been reported in most series. Dynamic stabilization without fusion in patients older than 60 years has not previously been compared with the use of posterior fusion in degenerative lumbar scoliosis.
To compare dynamic stabilization without fusion and posterior instrumented fusion in the treatment of degenerative lumbar scoliosis in elderly patients, in terms of perioperative findings, clinical outcomes, and adverse events.
A retrospective study.
Fifty-seven elderly patients were included. There were 45 women (78%) and 12 men (22%) with a mean age of 68.1 years (range, 61-78 years). All patients had degenerative de novo lumbar scoliosis, associated with vertebral canal stenosis in 51 cases (89.4%) and degenerative spondylolisthesis in 24 patients (42.1%).
Clinical (Oswestry Disability Index, visual analog scale, Roland-Morris Disability Questionnaire) and radiological (scoliosis and lordosis corrections) outcomes as well as incidence of complications.
Patients were divided into two groups: 32 patients (dynamic group) had dynamic stabilization without fusion and 25 patients (fusion group) underwent posterior instrumented fusion. All the patients' medical records and X-rays were reviewed. Preoperative, postoperative, and follow-up questionnaires were obtained to evaluate clinical outcomes.
At an average follow-up of 64 months (range, 42-90 months), clinical results improved similarly in both groups of patients. Statistically superior scoliosis and final lordosis corrections were achieved with posterior fusion (56.9% vs. 37.3% and -46.8° vs. -35.8°, respectively). However, in the dynamic group, incidence of overall complications was lower (25% vs. 44%), and fewer patients required revision surgery (6.2% vs. 16%). Furthermore, lower average values of operative duration (190 vs. 240 minutes) and blood loss (950 vs. 1,400 cc) were observed in the dynamic group than in the fusion group.
In elderly patients with degenerative lumbar scoliosis, pedicle screw-based dynamic stabilization was less invasive with shorter operative duration, less blood loss, and lower adverse event rates than instrumented posterior fusion. Scoliosis curve reduction and lumbar lordosis were superior after fusion; however, dynamic stabilization achieved satisfying values of both these parameters, and these results were stable after an average follow-up of more than 5 years. Furthermore, there was no difference between the two techniques in terms of functional clinical outcomes at the last follow-up.
经皮椎弓根螺钉内固定后外侧融合术目前是治疗老年退行性腰椎侧凸最广泛接受的技术。然而，大多数研究报告显示其并发症发生率较高。对于年龄大于 60 岁的患者，不进行融合的动态稳定与后融合治疗退行性腰椎侧凸尚未进行比较。
比较不融合的动态稳定与后融合治疗老年退行性腰椎侧凸患者的围手术期发现、临床结果和不良事件。
回顾性研究。
共纳入 57 例老年患者，其中女性 45 例（78%），男性 12 例（22%），平均年龄为 68.1 岁（范围：61-78 岁）。所有患者均为新发退行性腰椎侧凸，51 例（89.4%）伴有椎管狭窄，24 例（42.1%）伴有退行性腰椎滑脱。
临床（Oswestry 残疾指数、视觉模拟评分、Roland-Morris 残疾问卷）和影像学（脊柱侧凸和腰椎前凸矫正）结果以及并发症发生率。
患者分为两组：32 例（动态组）患者行不融合的动态稳定，25 例（融合组）患者行后路器械融合。所有患者的病历和 X 线片均进行了回顾。通过术前、术后和随访问卷评估临床结果。
平均随访 64 个月（范围：42-90 个月），两组患者的临床结果均有类似改善。后路融合在统计学上获得了更好的脊柱侧凸和最终腰椎前凸矫正（分别为 56.9% vs. 37.3%和-46.8° vs. -35.8°）。然而，在动态组中，总并发症发生率较低（25% vs. 44%），需要翻修手术的患者较少（6.2% vs. 16%）。此外，动态组的手术时间（190 分钟 vs. 240 分钟）和失血量（950cc vs. 1400cc）均低于融合组。
对于退行性腰椎侧凸的老年患者，基于椎弓根螺钉的动态稳定与后路器械融合相比，具有微创性，手术时间更短，失血量更少，不良事件发生率更低。融合后脊柱侧凸曲度和腰椎前凸矫正效果更好，但动态稳定可获得满意的脊柱侧凸和腰椎前凸矫正值，且这些结果在平均 5 年以上的随访后仍稳定。此外，在末次随访时，两种技术在功能临床结果方面没有差异。
