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Spine Surgery pp 481-488 | Cite as

Long Versus Short Constructs

  • Sebastian HartmannEmail author
  • Anja Tschugg
  • Claudius Thomé
Chapter

Abstract

Degenerative lumbar scoliosis (DLS) is associated with the focal development of coronal deformity due to degenerative changes in the mid portion of the lumbar spine. These degenerative changes are multifactorial and range from intervertebral disc degeneration and facet joint degeneration to changes in canal as well as pedicle morphology. The scoliotic curve typically progresses in the fifth decade of life with a life time prevalence of approximately 10% increasing with age. Especially older patients suffer from long curves with coronal deformity as well as abnormalities of sagittal spinopelvic parameters. Treatment strategies according to the approach (anterior, posterior, combined) as well as clear and formalized recommendations of short or long instrumentation techniques are lacking. Although single-level decompression procedures might be feasible in patients with predominantly claudicative symptoms, many patients develop multisegmental disease with long sagittally and coronally decompensated curves, so that simple decompression procedures may be expanded to “heavy metal” solutions. It is currently unclear, whether long fusion techniques with anterior, posterior or combined techniques are superior to short fusions. Due the associated complication rate, however, short fusion techniques might be favoured over long constructs, especially in older patients with comorbidities and an increased perioperative risk. Additionally, there is still an on-going discussion based on the distal fusion level for degenerative lumbar scoliosis. The question remains, whether the segment L5/S1 should be included in the construct or not, especially in the absence of disc degeneration at that level. This chapter will capture the treatment of degenerative lumbar scoliosis based on using short or long fusion constructs. Additionally, clinical outcome as well as potential complications associated with these two treatment strategies are discussed. Pitfalls are outlined at the end of the chapter.

References

  1. 1.
    Berjano P, Lamartina C. Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J. 2013;22(Suppl 2):S242–53.  https://doi.org/10.1007/s00586-012-2426-5.CrossRefPubMedGoogle Scholar
  2. 2.
    Berjano P, Lamartina C. Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine. Eur Spine J. 2014;23(9):1815–24.  https://doi.org/10.1007/s00586-014-3219-9.CrossRefPubMedGoogle Scholar
  3. 3.
    Bridwell KH, Edwards CC, Lenke LG. The pros and cons to saving the L5–s1 motion segment in a long scoliosis fusion construct. Spine (Phila Pa 1976). 2003;28(20S):S234–42.  https://doi.org/10.1097/01.BRS.0000092462.45111.27.CrossRefGoogle Scholar
  4. 4.
    Caputo AM, Michael KW, Chapman TM, Jennings JM, Hubbard EW, Isaacs RE, et al. Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis. J Clin Neurosci. 2013;20(11):1558–63.  https://doi.org/10.1016/j.jocn.2012.12.024.CrossRefPubMedGoogle Scholar
  5. 5.
    Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D. Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine (Phila Pa 1976). 2012;37(8):693–700.  https://doi.org/10.1097/BRS.0b013e31822ff5c1.CrossRefGoogle Scholar
  6. 6.
    Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Lee TJ, et al. Short fusion versus long fusion for degenerative lumbar scoliosis. Eur Spine J. 2008;17(5):650–6.  https://doi.org/10.1007/s00586-008-0615-z.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Edwards CC, Bridwell KH, Patel A, Rinella AS, Berra A, Lenke LG. Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis. Spine (Phila Pa 1976). 2004;29(18):1996–2005.CrossRefGoogle Scholar
  8. 8.
    Lee C-H, Chung CK, Sohn MJ, Kim CH. Short limited fusion versus long fusion with deformity correction for spinal stenosis with balanced de novo degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2017;42(19):E1126–32.  https://doi.org/10.1097/BRS.0000000000002306.CrossRefGoogle Scholar
  9. 9.
    Park SJ, Lee CS, Chung SS, Lee JY, Kang SS, Park SH. Different risk factors of proximal junctional kyphosis and proximal junctional failure following long instrumented fusion to the sacrum for adult spinal deformity: survivorship analysis of 160 patients. Neurosurgery. 2017;80(2):279–86.  https://doi.org/10.1227/NEU.0000000000001240.CrossRefPubMedGoogle Scholar
  10. 10.
    Phan K, Xu J, Maharaj MM, Li J, Kim JS, Di Capua J, et al. Outcomes of short fusion versus long fusion for adult degenerative scoliosis: a systematic review and meta-analysis. Orthop Surg. 2017;9(4):342–9.  https://doi.org/10.1111/os.12357.CrossRefPubMedGoogle Scholar
  11. 11.
    Pritchett JW, Bortel DT. Degenerative symptomatic lumbar scoliosis. Spine (Phila Pa 1976). 1993;18(6):700–3.CrossRefGoogle Scholar
  12. 12.
    Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS. Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus. 2010;28(3):E7.  https://doi.org/10.3171/2010.1.FOCUS09263.CrossRefPubMedGoogle Scholar
  13. 13.
    Tribus CB. Degenerative lumbar scoliosis: evaluation and management. J Am Acad Orthop Surg. 2003;11(3):174–83.CrossRefGoogle Scholar
  14. 14.
    Wang G, Hu J, Liu X, Cao Y. Surgical treatments for degenerative lumbar scoliosis: a meta analysis. Eur Spine J. 2015;24(8):1792–9.  https://doi.org/10.1007/s00586-015-3942-x.CrossRefPubMedGoogle Scholar
  15. 15.
    Wang H, Ma L, Yang D, Wang T, Yang S, Wang Y, et al. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion. Medicine (Baltimore). 2016;95(32):e4443.  https://doi.org/10.1097/MD.0000000000004443.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sebastian Hartmann
    • 1
    Email author
  • Anja Tschugg
    • 1
  • Claudius Thomé
    • 1
  1. 1.Department of NeurosurgeryMedical University InnsbruckInnsbruckAustria

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