184. Selection of Proximal Fusion Level in Adult Lumbar Segemnetal Instrumented Fusion to L5 or S1 for Degenerative Lumbar Scoliosis

2009 ◽  
Vol 9 (10) ◽  
pp. 96S-97S
Author(s):  
Yongjung Kim ◽  
Oheneba Boachie-Adjei ◽  
Keith Bridwell ◽  
Lawrence Lenke ◽  
Youngbae Kim ◽  
...  
Keyword(s):  
Degenerative Lumbar Scoliosis ◽  
Instrumented Fusion ◽  
Lumbar Scoliosis ◽  
Fusion Level ◽  
Selection Of

scholarly journals Selection of proximal fusion level for adult degenerative lumbar scoliosis

2012 ◽  
Vol 22 (2) ◽  
pp. 394-401 ◽  
Author(s):  
Kyu-Jung Cho ◽  
Se-Il Suk ◽  
Seung-Rim Park ◽  
Jin-Hyok Kim ◽  
Jae-Hoon Jung
Keyword(s):  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Fusion Level ◽  
Selection Of

scholarly journals Comparison between dynamic stabilization and instrumented fusion in the treatment of spinal stenosis with degenerative lumbar scoliosis

2019 ◽  
Author(s):  
Lei Luo ◽  
Lang Fang ◽  
Qiang Zhou ◽  
Chen Zhao ◽  
Pei Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Perioperative Complications ◽  
Dynamic Stabilization ◽  
Degenerative Lumbar Scoliosis ◽  
Instrumented Fusion ◽  
Lumbar Scoliosis ◽  
Significant Difference ◽  
Posterior Instrumented Fusion

Abstract Background Posterior instrumented fusion is the most widely accepted surgical treatment for spinal stenosis with degenerative lumbar scoliosis (DLS). However, long fusion can affect daily activities due to lumbar stiffness. Several clinical studies have shown that Dynesys dynamic stabilization in addition to laminectomy could lead to significant improvements in clinical outcomes. This study aimed to compare the outcomes of Dynesys dynamic stabilization with posterior instrumented fusion for the management of spinal stenosis with DLS. Methods Between August 2010 and Deccember 2015, a total of 46 patients with spinal stenosis and degenerative lumbar scoliosis were enrolled in this study. 26 patients (Dynesys group) had fenestration decompression, selective intervertebral fusion and Dynesys stabilizationin. 20 patients (fusion group) underwent posterior instrumented fusion. Clinical outcomes, radiographic data, and perioperative complications were compared between the two groups. The average duration of follow-up for the Dynesys group and fusion group was 38 and 33 months respectively. Results The mean number of fixed segments were 3.3±0.8 in Dynesys group and 4.3±0.8 in fusion group. Lower average values of operative duration and blood loss were observed in the dynamic group than in the fusion group. VAS for back and leg pain improved in both groups of patients. There were significant difference in ODI and LSDI (lumbar stiffness disability index) between Dynesys group and fusion group at the last follow-up. The scoliosis Cobb's angle and lumbar lordosis significantly improved in both groups after surgery, and no significant difference were observed between the groups at the last follow-up (P＞0.05). Dynesys stabilization resulted in significantly higher preservation of motion at the implanted segments. Conclusions This study demonstrated that both Dynesys dynamic stabilization and instrumented fusion can improve clinical outcomes of patients with degenerative lumbar scoliosis. Compared to instrumented fusion, Dynesys stabilizationin have advantages on blood loss, operation time, perioperative complications. In addition, Dynesys stabilization partially preserves the ROM of the stabilized segments that may reduce the limitation on daily activities caused by lumbar stiffness. Dynesys stabilizationin can also correct scoliosis, prevent progression of the curve, and maintain lumbar lordosis in mild to moderate lumbar scoliosis without sagittal imbalance.

scholarly journals Proximal Fusion Level Above First Coronal Reverse Vertebrae: An Essential Factor Decreasing the Risk of Adjacent Segment Degeneration in Degenerative Lumbar Scoliosis

2021 ◽  
pp. 219256822199408
Author(s):  
Hui Wang ◽  
Zhuoran Sun ◽  
Longjie Wang ◽  
Da Zou ◽  
Weishi Li
Keyword(s):  
Mechanical Load ◽  
Stable Condition ◽  
Adjacent Segment Degeneration ◽  
Control Group ◽  
Adjacent Segment ◽  
Study Group ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Fusion Level ◽  
Scoliosis Progression

Study Design: Retrospective radiological analysis. Objective: To explore whether proximal fusion level above first coronal reverse vertebrae (FCRV) could decrease risk of adjacent segment degeneration (ASD) in degenerative lumbar scoliosis (DLS). Methods: One hundred and 16 DLS patients were divided into 2 groups according to occurrence of ASD: study group (ASD positive group) and control group (ASD negative group). FCRV was defined as the first vertebrae that presents opposite orientation of asymmetric Hounsfield unit (HU) ratio from the other vertebrae within major curve. Incidence of ASD was evaluated in subgroups according to location between FCRV and upper instrumented vertebrae (UIV). Results: The fusion level was shorter in study group than that in control group. There were 12 patients presented FCRV 2-level proximal than SV, 32 patients presented FCRV 1-level proximal than SV, 35 patients presented the same vertebra of FCRV with SV, 23 patients presented FCRV 1-level distal than SV, 14 patients presented FCRV 2-level distal than SV. When UIV located above FCRV, no patient presented ASD, while 15.4% patients presented ASD when UIV located on FCRV. In study group, proximal scoliosis progression was detected in 1 patient (3.9%) when UIV located on FCRV, and 17 patients (29.8%) when UIV located below FCRV. Conclusions: Proximal fusion level above FCRV could decrease the risk of ASD in DLS, especially for the proximal scoliosis progression. FCRV represent the transitional point of the mechanical load on coronal plane, and may be within a more stable condition than stable vertebrae measured from radiographs.

Impact of shift to the concave side of the C7-center sacral vertical line on de novo degenerative lumbar scoliosis progression in elderly volunteers

2020 ◽  
Vol 25 (1) ◽  
pp. 82-88
Author(s):  
Hiroki Ushirozako ◽  
Go Yoshida ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
De Novo ◽  
Concave Side ◽  
Vertical Line ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Scoliosis Progression

scholarly journals Evaluation of Lumbar Stiffness after Long-Level Fusion  for Degenerative Lumbar Scoliosis in Chinese population

2020 ◽  
Author(s):  
Xinling Zhang ◽  
Lei Yuan ◽  
Yan Zeng ◽  
Zhongqiang Chen ◽  
Weishi Li ◽  
...  
Keyword(s):  
Internal Consistency ◽  
Chinese Population ◽  
Chinese Patients ◽  
Personal Hygiene ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Patient Reported ◽  
Elderly Chinese ◽  
The Impact ◽  
Level Fusion

Abstract Study Design: a retrospective study.Summary of Background Data: Long-level spinal instrumented fusion for DLS by intention eliminated spinal motion in an attempt to alleviate pain, improve deformity, and reduce disability. However, this surgery considerably impaired performance of activities of daily living (ADL) due to the resulting stiffness. The lumbar stiffness disability index (LSDI) was a validated measure of the effect of lumbar stiffness on functional activity, however, which might not be fully applicable to elderly Chinese population because of their several special lifestyles.Objective: To evaluate the lumbar stiffness in patients with degenerative lumbar scoliosis (DLS) after long-level fusion by Chinese-LSDI (C-LSDI).Methods: 129 DLS patients underwent long-level (≧4 levels) fusion surgery with at least one-year follow-up were included. The C-LSDI was designed by modifying LSDI and Korean-LSDI (K-LSDI) considering elderly Chinese lifestyles, and the patient-reported outcome questionnaire measuring the impact of lumbar stiffness on functional abilities in elderly Chinese with DLS was assessed for internal consistency and retest repeatability.Results: All patients showed increased lumbar stiffness with significantly improvement in pain and deformity postoperatively, and for items of performing personal hygiene after toileting and getting out of a car, people performed more inconvenient with increasing fixed levels. Compared with LSDI and K-LSDI, the C-LSDI demonstrated high internal consistency (Cronbach’s alpha=0.902) and retest reliability (ICC=0.904) in the elderly Chinese population. Conclusion: This study demonstrated that the C-LSDI questionnaire was a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among elderly Chinese patients with DLS after long-level fusion. Although the effects of stiffness did trend toward greater impacts among patients underwent longer fusions, most patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.

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