Mid- and Long-Term Comparison Analysis of Two Approaches for the Treatment of Level III or Higher Lenke-Silva Adult Degenerative Scoliosis: Radical or Limited Surgery?

OBJECTIVE

As the population in general is living longer, less invasive adult degenerative scoliosis (ADS) surgery that balances risks and benefits requires long-term clinical outcomes to determine its strengths and weaknesses. We design a retrospective study to compare the postoperative mid- and long-term outcomes in terms of efficacy, surgical complications, and reoperation rate of patients with ADS treated with two different surgical approaches (long-segment complete reconstruction or short-segment limited intervention).

METHODS

In this retrospective study, 78 patients with ADS (Lenke-Silva levels III or higher), who accepted surgical treatment at our hospital between June 2012 and June 2019 were included. These patients were assigned to the long-segment radical group (complete decompression with deformity correction involves ≥3 segments) and the short-segment limited group (symptomatic segment decompression involves <3 segments). In addition, general information such as age, gender, fixed segment number, efficacy, radiographic parameters, and reoperation rate of patients in the two groups were compared and analyzed.

RESULTS

There were no significant differences between the two groups with regard to gender, follow-up time, long-term surgical complications and reoperation rate (P > 0.05). The mean age of patients in the long-segment strategy group was 57.1 ± 7.9 years, with a mean number of fixed segments of 7.9 ± 2.4. The mean age of patients in the short-segment strategy group was 60.8 ± 8.4 years, with a mean number of fixed segments of 1.4 ± 0.5. At the final follow-up visit, the long-segment radical group showed better results than the short-segment limited group with regard to coronal Cobb angle, lumbar lordosis angle and sagittal balance (P < 0.05). The long-segment strategy group had a higher implant-related complication rate (P = 0.010); the adjacent segment-related complication in the two groups showed no significant difference (P = 0.068).

CONCLUSION

Considering the risk, rehabilitation pathway and costs of long-segment radical surgery, short-segment limited intervention is a better strategy for patients who cannot tolerate the long-segment surgery, improving symptoms and maintaining efficacy in the mid- and long-term, and not increasing the reoperation rate.