Comparison of Short Fusion versus Long Fusion for Degenerative Lumbar Scoliosis

Methods: Forty-seven patients undergoing short fusion (n=28) and long fusion and instrumentation (n=19) were evaluated with a minimum 2-yr follow up. Short fusion was defined as the fusion within scoliotic deformity, and long fusion as the fusion up to more proximal segment to upper end vertebra. The upper end vertebra was L1 in 22 patients and L2 in 15 patients. The fusion level was 3.14±0.97 segments in short fusion and 6.89±1.29 in long fusion. Patients' age and number of co-morbidities were similar in both groups. (See Table)

Results: Before surgery, the scoliotic angle was 16.3o (range 11-28) in short fusion and 22o (range 12-33) in long fusion. The correction of the curve was better in long fusion than short fusion (P=0.001). Mean EBL was more abundant in long fusion (2742ml±1315) than in short fusion (1671ml±604.8) (P=0.001). Operative time (179 min vs 224 min, P=0.009) and hospital stay (18.4 day vs 24.2 day, P=0.008) was longer in long fusion group. There were substantial complications in both groups, 15 of 28 short fusion and 17 of 19 long fusion. Pseudarthrosis was noted in 2 patients of long fusion, whereas no pseudarthrosis in short fusion group. There were 10 adjacent segment disease in short fusion, whereas 6 adjacent segment disease in long fusion group. The improvement of Oswestry score was similar in both groups (P=0.137).

Conclusion: The long fusion and instrumentation for degenerative lumbar scoliosis was better to correct the scoliotic deformity than short fusion, but demonstrated more blood loss and longer hospital stay. The early perioperative and late complications developed at similar rate in both groups. The Oswestry score at the last visit was identical in both groups.