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?

Abstract

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.

Keywords: Adult degenerative scoliosis; Long-segment fixation; Postoperative complication; Reoperation; Short-segment fixation.