A clinical analysis of short-segment fixation and fusion for degenerative lumbar scoliosis combined with lumbar stenosis

QIANG Zhe; SONG Yue-ming; LIU Li-min; YANG Xi; HU Xing-xin; LING Ting-xian

doi:10.3969/j.issn.2095-252X.2015.03.007

Abstract：Objective To explore the surgical strategies and clinical results of short-segment fixation and fusion for degenerative lumbar scoliosis combined with lumbar stenosis. Methods Twenty-six patients with degenerative lumbar scoliosis combined with lumbar stenosis who underwent short-segment ifxation and fusion from May 2010 to August 2013 were recruited for this retrospective study. There were 11 males and 15 females, whose mean age was 64.1 years old ( range:52-78 years ). The preoperative X-ray of the total spine showed the mean Cobb’s angle was 16.4° ( range:11°-26° ) and the mean lumbar lordosis angle was 27.3° ( range:12°-46° ). Pain and function were assessed by Oswestry disability index ( ODI ). Selective decompression and short-segment ifxation and fusion were performed. The Cobb’s angles, lumbar lordosis angles and ODI before the operation and during the follow-up were compared. Results All the patients were followed up for a mean period of 20 months. The mean Cobb’s angle was decreased from ( 16.4±3.8 ) ° preoperatively to ( 6.9±2.2 ) ° postoperatively, and the correction rate was 58%. The lumbar lordosis angle was increased from ( 27.3±7.9 ) ° preoperatively to ( 33.5±5.9 ) ° in the latest follow-up. The coronal balance was decreased from ( 11.2±4.5 ) mm preoperatively to ( 5.2±2.3 ) mm postoperatively and the sagittal balance was decreased from ( 11.7±6.0 ) mm preoperatively to ( 6.0±2.3 ) mm postoperatively. The ODI was obviously reduced in the latest follow-up, and the improvement rate was 83.1%. There were 19 excellent cases, 6 good cases and 1 fair case. Statistically signiifcant differences existed when all the preoperative parameters were compared with the postoperative ones ( P<0.05 ). The early complication incidence was 26.9%. There was no instrument-related failure. Conclusions The surgical strategy of selective decompression and short-segment ifxation and fusion is effective for the patients with small Cobb’s angle (<30° ) and minor spinal imbalance.