Institute of Orthopaedics, Xijing Hospital, The Air Force Medical University (The Fourth Military Medical University), No. 127 Changle Xi Road, Xi'an, Shanxi province, P.R. China.
Spine (Phila Pa 1976). 2020 Aug 1;45(15):1047-1054. doi: 10.1097/BRS.0000000000003465.
Retrospective observational cohort study.
To compare the benefits of long and short fusion treatments, and to identify factors potentially aiding surgeons' decision making about the surgical management of degenerative lumbar scoliosis associated with spinal stenosis (DLSS).
The comparative effectiveness of long and short segment fusion for the treatment of DLSS remains controversial.
Fifty-three patients with symptomatic DLSS managed by posterior-only fusion surgery were enrolled in this study. Twenty patients underwent short fusion (fewer than two segments), and 33 patients had more than three segments fused. The radiological outcomes were assessed by radiography. Health-related quality of life data, including visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were collected at all preoperative and follow-up visits.
The short and long fusion groups showed significant differences in the change in the Cobb angle (4.2° vs. 11.2°), lumbar lordosis (3.9° vs. 11.5°), and pelvic incidence minus the lumbar lordosis angle (PI - LL; 3.2° vs. 11.2°). Both the short and long fusion achieved significant changes in low back pain and leg pain. Patients with PI -LLs > 10° had more relief of low back pain after long fusion (VAS 4.0 ± 2.0) than after short fusion (VAS 2.6 ± 1.7). Patients with PI - LLs > 10° showed significantly improved walking ability after long fusion (ODI 1.0 ± 0.8). The improvement in standing ability after short fusion was greater when PI - LL ≤ 10°(ODI 0.9 ± 0.6).
Long segment fusion can relieve low back pain better and improve walking ability when PI-LL is mismatched, whereas short segment fusion is more advantageous in improving standing ability in cases of more balanced sagittal spinopelvic alignment.
回顾性观察队列研究。
比较长节段与短节段融合治疗的疗效，并确定有助于外科医生对伴椎管狭窄的退行性腰椎侧凸（DLSS）的手术治疗决策的潜在因素。
长节段与短节段融合治疗 DLSS 的疗效比较仍存在争议。
本研究纳入了 53 例接受单纯后路融合手术治疗的有症状的 DLSS 患者。20 例患者行短节段融合（融合节段少于 2 个），33 例患者行超过 3 个节段融合。通过影像学评估放射学结果。在所有术前和随访时采集健康相关生活质量数据，包括视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分。
短节段和长节段融合组的 Cobb 角（4.2° vs. 11.2°）、腰椎前凸（3.9° vs. 11.5°）和骨盆入射角减去腰椎前凸角（PI - LL；3.2° vs. 11.2°）的变化有显著差异。短节段和长节段融合均能显著改善下腰痛和腿痛。PI - LL 大于 10°的患者长节段融合后下腰痛缓解更明显（VAS 4.0±2.0），而短节段融合后（VAS 2.6±1.7）缓解更差。PI - LL 大于 10°的患者长节段融合后行走能力显著改善（ODI 1.0±0.8）。PI - LL 小于等于 10°时，短节段融合后站立能力改善更大（ODI 0.9±0.6）。
PI - LL 不匹配时，长节段融合可更好地缓解下腰痛，改善行走能力；而当矢状位脊柱骨盆平衡较好时，短节段融合更有利于改善站立能力。
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