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Does It Make a Difference to Stop Fusion at L3 Versus L4 in Terms of Disc and Facet Joint Degeneration: An MRI Study With Minimum 5 Years Follow-up

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Abstract

Objectives

To compare the functional outcomes of patients with idiopathic scoliosis who had surgical correction and fusion with all pedicle screw construct down to L3 or L4 and to evaluate whether saving a mobile lumbar motion segment distally would demonstrate any difference in terms of disc degeneration (DD) and facet joint degeneration (FJD) after minimum 5 years follow-up.

Summary of Background Data

Selection of lowest instrumented vertebra (LIV) is often difficult when lumbar curve was included into the fusion (L3 vs L4). Saving L4 is believed to be beneficial for preserving motion and preventing degeneration of unfused lumbar spine.

Methods

The L3 group included 21 patients (mean age of 21.4) and L4 group included 16 patients (mean age 22.9). Control group included 30 healthy individuals with no spinal deformities (mean age of 23.8). Follow-up lumbar magnetic resonance images (MRIs) were evaluated for each patient in terms of DD and FJD. Clinical evaluation was done by using the Scoliosis Research Society–22r, Oswestry Disability Index, and Numeric Rating Scale.

Results

Mean follow-up period was 7.4 (5–10) years in the L3 group and 9 (5–17) years in L4 group. Average correction rates for lumbar curve magnitudes were 78% in the L3 group and 79% in the L4 group, with no significant correction loss at the final follow-up. There was no statistical difference for DD in all groups (p >.05). FJD was significantly greater in both L3 and L4 groups compared to the control group (p <.001). Clinical outcome scores were similar among all three groups (p >.05).

Conclusion

Spinal balance and corrections remained stable, without showing any decompensation over time. This midterm MRI study demonstrated similar disc and facet degeneration rates for L3 and L4 groups. FJD at the upper two levels adjacent to the LIV was significant for both surgically treated groups. Clinical outcome scores were similar for all groups at minimum 5 years follow-up.

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Authors and Affiliations

  1. Istanbul Spine Center at Florence Nightingale Hospital, Abide-i Hurriyet Cad. No:166, Sisli, Istanbul, 34381, 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, Abide-i Hurriyet Cad. No:160, Sisli, Istanbul, 34381, Turkey

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

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

    Sinan Yilar MD

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

    Mutlu Cobanoglu MD

  5. Department of Radiology, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No:166, Sisli, Istanbul, 34381, Turkey

    Ayhan Mutlu MD & Levent Onur Ulusoy MD

  6. Department of Orthopaedics and Traumatology, Acibadem University Faculty of Medicine, Buyukdere Cad. No:40 Maslak, Sariyer, Istanbul, 34457, Turkey

    Ahmet Alanay MD

Authors
  1. Meric Enercan MD
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  2. Sinan Kahraman MD
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  3. Sinan Yilar MD
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  4. Mutlu Cobanoglu MD
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  5. Bahadir Huseyin Gokcen MD
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  6. Selhan Karadereler MD
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  7. Ayhan Mutlu MD
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  8. Levent Onur Ulusoy MD
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  9. Cagatay Ozturk MD
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  10. Erden Erturer 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

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

Author Disclosures

ME (none); SK (none); SY (none); MC (none); BHG (none); SK (none); AM (none); LOU (none); CO (nonfinancial support from Medtronic, outside the submitted work); EE (none); EG (none); TS (none); AA (nonfinancial support from Medtronic, non-financial support from DePuy-Synthes, during the conduct of the study); AH (nonfinancial support from Medtronic, outside the submitted work).

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Enercan, M., Kahraman, S., Yilar, S. et al. Does It Make a Difference to Stop Fusion at L3 Versus L4 in Terms of Disc and Facet Joint Degeneration: An MRI Study With Minimum 5 Years Follow-up. Spine Deform 4, 237–244 (2016). https://doi.org/10.1016/j.jspd.2015.12.001

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  • DOI: https://doi.org/10.1016/j.jspd.2015.12.001

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