Clinical efficacy of short segment and long segment internal fixation fusion in the treatment of degenerative scoliosis
JIANG Ze-hua,ZHANG Hong-jie,LU Qing
Abstract:
Objective To compare the efficacy of long-segment and short-segment internal fixation and fusion surgeries in the treatment of patients with adult degenerative scoliosis (ADS). Methods A retrospective analysis was conducted on 61 patients with ADS, who were divided into a long-segment fixation group(n=32) and a short-segment fixation group(n=29) based on the number of instrumented segments. The perioperative follow-up outcomes, complications, and radiological data were compared between the two groups. Results The short-segment fixation group demonstrated significantly shorter operative time, less blood loss, fewer fluoroscopy counts, shorter hospital stays, and lower total hospitalization costs compared to the long-segment fixation group (P <0.05). One year postoperatively, both groups showed significant improvements in Visual Analog Scale (VAS) scores for low back pain and lower limb pain, as well as in the Oswestry Disability Index (ODI) compared to preoperative values (P <0.05). In intergroup comparison, except for a more pronounced improvement in the VAS score for low back pain in the short-segment group (P <0.05), there were no significant differences in the improvement values of the other scores between the two groups (P >0.05). Follow-up radiological data revealed that, within the long-segment fixation group, the Cobb angle, sagittal vertical axis (SVA), and pelvic tilt (PT) decreased, while the sacral slope (SS) and lumbar lordosis (LL) increased one year postoperatively (P <0.05). In the short-segment fixation group, the Cobb angle and PT decreased, and the LL and SS increased one year postoperatively (P <0.05). Intergroup comparison at one year postoperatively showed significant differences in thoracic kyphosis (TK) and SS between the two groups (P <0.05), whereas no statistically significant differences were observed in the Cobb angle, SVA, PT, pelvic incidence (PI) or LL (P ＞0.05). The incidence rates of postoperative complications were 31.25% in the long-segment fixation group and 10.34% in the short-segment fixation group, with a statistically significant difference (P =0.046). Conclusion Both long-segment and short-segment internal fixation demonstrate effective outcomes in alleviating clinical symptoms and correcting spinal-pelvic parameters in patients with ADS. The short-segment fixation group experiences less trauma and fewer complications.
