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The Effects of Spinal Fusion on Lumbar Disc Degeneration in Patients with Adolescent Idiopathic Scoliosis: A Minimum 10-Year Follow-Up

  • Long-Term Follow-Up Case Series
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Abstract

Study design

Retrospective study.

Objectives

This study focused on patients with adolescent idiopathic scoliosis (AIS) who were followed up for more than 10 years, and assessed the influence of spinal balance on lumbar degenerative changes at distal unfused segments (DUS).

Summary of Background Data

Previous studies suggested that longer fusion segments may result in higher rates of occurrence of disc degeneration (DD) at unfused segments adjacent to the distal fused area. However, there are no existing studies that correlate the degree of DD to the location of lower instrumented vertebra (LIV) and the amount of the residual lumbar curve during the follow-up period.

Methods

Radiologic measurements were recorded at the time of surgery, immediately after surgery, and 10 years after surgery. The Pfirrmann grading scale was used to rate the MR images of these patients. The presence of vertebral DD was also used to classify patients into DD+ and DD- groups.

Results

93 patients with AIS participated in this study. The average age at the time of surgery was 15. 2 years; the average follow-up time was 154 months. DD was found in 45 patients (48%) and L5/S1 was the most common (40%) location in those patients. The LI group experienced DD at a frequency of 34%, whereas the frequency increased with lower LIV placement. There was a significant difference between DD+ and DD- in age at the time of operation, the L4 tilt (pre Op. and post. 10 years), and the number of mobile segments.

Conclusions

Disc degeneration occurred in 48% of the patients at the time of postop. 10 years. Disc degeneration had a tendency to occur in patients with greater preoperative and postoperative 10 years L4 tilt angle and fewer mobile segments in the lower lumbar spine.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Department of Orthopedics and Spine Surgery, Meijo Hospital, Naka-ku, Nagoya City, Aichi Prefecture, 460-0001, Japan

    Ayato Nohara MD, Noriaki Kawakami MD, DMSc, Taichi Tsuji MD, Tetsuya Ohara MD, Toshiki Saito MD & Kazuki Kawakami BKin

  2. Department of Orthopedics, Tenriyorozu Soudanzyo Hospital, 200 Misima-cho, Tenri, Nara prefecture, 632-8552, Japan

    Kenji Seki MD

Authors
  1. Ayato Nohara MD
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  2. Noriaki Kawakami MD, DMSc
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  3. Kenji Seki MD
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  4. Taichi Tsuji MD
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  5. Tetsuya Ohara MD
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  6. Toshiki Saito MD
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  7. Kazuki Kawakami BKin
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Corresponding author

Correspondence to Noriaki Kawakami MD, DMSc.

Additional information

This paper is designed and submitted per the guidelines of the institutional review board of the Meijo Hospital, and all patients have signed consent forms for this study.

No funds were received in support of this work.

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Nohara, A., Kawakami, N., Seki, K. et al. The Effects of Spinal Fusion on Lumbar Disc Degeneration in Patients with Adolescent Idiopathic Scoliosis: A Minimum 10-Year Follow-Up. Spine Deform 3, 462–468 (2015). https://doi.org/10.1016/j.jspd.2015.04.001

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  • DOI: https://doi.org/10.1016/j.jspd.2015.04.001

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