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Selective Thoracic Fusion Provides Similar Health-Related Quality of Life but Can Cause More Lumbar Disc and Facet Joint Degeneration: A Comparison of Adolescent Idiopathic Scoliosis Patients With Normal Population 10 Years After Surgery

  • Long-Term Follow-Up Case Series
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Abstract

Objectives

To evaluate the long-term behavior of the lumbar curve in patients with adolescent idiopathic scoliosis treated with selective thoracic fusion and to assess the clinical and radiologic outcomes in this fusion group compared with an age- and gender-matched group.

Summary of Background Data

Selective thoracic fusion for the treatment of adolescent idiopathic scoliosis (AIS) preserves lumbar motion segments but leaves a residual deformity. By avoiding fusion of the lumbar spine, a greater mobility may be preserved, which may be an advantage in long-term follow-up in terms of degenerative changes in unfused segments.

Methods

Group A included 25 AIS patients with mean a age of 23. 8 years and a mean 11. 4 years of follow-up. Group B included 30 age-and gender-matched subjects without any deformity. Preoperative, postoperative, and follow-up radiographs were reviewed. All patients had MRIs taken at the final follow-up in order to evaluate disc degeneration (DD) and facet joint degeneration (FJD) at the unfused lumbar spine. Clinical evaluation was done by using Scoliosis Research Society-22R, Oswestry Disability Index, and numerical rating scale.

Results

Sagittal and coronal balance and lowest instrumented vertebra disc angulation were stable overtime. Mean grading of lumbar DD was 2. 16 (2-4) in Group A and 1. 86 (1-3) in Group B. Lumbar FJDs were 2. 05 (1 -4) in Group A and 1. 60 (1-3) in Group B. There was significant difference between the two groups for DD except for the L4-L5 level (p =. 26). FJD was significantly higher in the L1-L2 and L2-L3 levels (LI-L2, p =. 002, L2-L3, p =. 002) but not for the other levels. Outcome scores were similar without significant differences between the two groups (p >. 05).

Conclusion

Selective thoracic fusion provides satisfactory outcomes at more than 10 years of follow-up. Our study demonstrated a moderate increase in the rate of disc degeneration in the unfused segments. Facet joint degeneration was significant at the upper two levels adjacent to the lowest instrumented vertebra.

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Author information

Authors and Affiliations

  1. Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No: 166 Sisli, 34381, Istanbul, Turkey

    Meric Enercan MD, Selhan Karadereler MD, Elif Gebes PT, Tunay Sanli MA & Azmi Hamzaoglu MD

  2. Department of Orthopaedics and Traumatology, Istanbul Bilim University Faculty of Medicine, Gayrettepe Mh, 34349, İstanbul, Turkey

    Sinan Kahraman MD, Bahadir Huseyin Gokcen MD, Cagatay Ozturk MD & Erden Erturer MD

  3. Department of Orthopaedics and Traumatology, Adnan Menderes University Faculty of Medicine, Merkez Kampusu Aytepe Mevkii, 09100, Aydin, Turkey

    Mutlu Cobanoglu MD

  4. Department of Orthopaedics and Traumatology, Erzurum Ataturk University Faculty of Medicine, Vani Efendi Mah. Yakutiye, 2540, Erzurum, Turkey

    Sinan Yilar MD

  5. Department of Radiology, Florence Nightingale Hospital, Gokiurk Merkez Mh., Gökürk Cd. No:25/A Bl, 34077, Eyüp, İstanbul, Turkey

    Ayhan Mutlu MD & Levent Onur Ulusoy MD

  6. Department of Orthopaedics and Traumatology, Acibadem University Faculty of Medicine, Kayisdagi Cd. No: 32, 34755, Atasehir Istanbul, Turkey

    Ahmet Alanay MD

Authors
  1. Meric Enercan MD
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  2. Sinan Kahraman MD
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  3. Mutlu Cobanoglu MD
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  5. Bahadir Huseyin Gokcen MD
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  8. Levent Onur Ulusoy MD
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  9. Cagatay Ozturk MD
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  11. Elif Gebes PT
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  12. Tunay Sanli MA
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  13. Ahmet Alanay MD
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  14. Azmi Hamzaoglu MD
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Corresponding author

Correspondence to Meric Enercan MD.

Additional information

Author disclosures: ME (none); SiK (none); MC (none); SY (none); BHG (none); SeK (none); AM (none); LOU (none); CO (reports nonfinan-cial support from Medtronic, outside the submitted work); EE (none); EG (none); TS (none); AA (reports nonfinancial support from Medtronic, nonfinancial support from DePuy-Synthes, outside the submitted work); AH (reports nonfinancial support from Medtronic, outside the submitted work)

This study was performed at the Istanbul Spine Center, Florence Nightingale Hospital, Istanbul, Turkey.

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Enercan, M., Kahraman, S., Cobanoglu, M. et al. Selective Thoracic Fusion Provides Similar Health-Related Quality of Life but Can Cause More Lumbar Disc and Facet Joint Degeneration: A Comparison of Adolescent Idiopathic Scoliosis Patients With Normal Population 10 Years After Surgery. Spine Deform 3, 469–475 (2015). https://doi.org/10.1016/j.jspd.2015.07.001

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  • DOI: https://doi.org/10.1016/j.jspd.2015.07.001

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