Curve progression in de novo degenerative lumbar scoliosis combined with degenerative segment disease after short-segment fusion

PurposeTo validate the reliability of Berjano and Lamartina classification system of surgical planning in cases of de novo degenerative lumbar scoliosis (DNDLS) combined with degenerative segment disease and identify factors contributing to curve progression.MethodsFifty-four cases of type I or II DNDLS were retrospectively reviewed. Health-related quality of life (HRQOL) was assessed using visual analogue scale (VAS) scores for the back and leg, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Radiographic parameters were obtained from X-rays. Improvements in HRQOL were confirmed by a paired t test. Changes in radiographic parameters were confirmed by paired t test and Wilcoxon signed-rank test. Clinical relevance between spinopelvic parameters and Cobb angle progression was analyzed by Spearman correlation coefficient.ResultsThe mean follow-up period was 36.814.8 months. The scores taken preoperatively versus at the last follow-up were as follows: mean VAS back score, 4.52.4 versus 1.8 +/- 1.5 (p<0.01); and mean VAS leg score, 5.2 +/- 2.5 versus 1.7 +/- 2.1 (p<0.01). The ODI score improved from 25.3 +/- 8.9% to 10.1 +/- 5.4% (p<0.01), whereas the mean JOA score improved from 14.3 +/- 4.9 to 21.0 +/- 3.7 (p<0.01). The mean Cobb angle decreased from 17.1 degrees +/- 7.4 degrees to 9.4 degrees +/- 4.5 degrees postoperatively but worsened to 14.1 degrees +/- 6.4 degrees at the last follow-up with a mean progression of 2.1 degrees per year. Cobb angle correction was lost at a mean 2.1 degrees +/- 3.3 degrees per year with correlation to T1 pelvic angle and sagittal vertical axis preoperatively.Conclusions p id=Par4 Selective decompression and short-segment fusion were effective for treating type I and II cases DNDLS. The Cobb angle increased relative to preoperative sagittal spine alignment.