Abstract
Background
Degenerative spinal diseases may lead to multisegmental instabilities and present as de novo scoliosis. Due to frequent primary and secondary complications, their treatment is controversial among spine surgeons. The aim of this systematic review is to investigate the postoperative quality of life after multilevel fusion surgery for de novo scoliosis. Furthermore, technical aspects and complications are examined in detail.
Methods
A systematic literature search was conducted, excluding systematic reviews or meta-analyses. A follow-up period of at least 24 months was required. Standardised outcome instruments on quality of life, epidemiological data and information on surgical technique and any further follow-up examinations were extracted. Studies on adolescents or neuromuscular scoliosis were excluded, as were case reports and studies on short-span fusions.
Results
Twenty studies were included in the systematic review. The Oswestry Disability Index (ODI) was reported in 15 studies. All authors reported significant improvements. Inclusion of the L5/S1 segment showed no differences in quality of life, but better radiological correction, although the rate of adjacent segment degeneration and complications was higher. The data on general postoperative complications ranged from 10.5% to 71.5%.
Conclusions
Quality of life after multilevel fusion for de novo scoliosis shows significant improvements. There is no general recommendation on the last instrumented vertebra or the caudal anchoring of the instrumentation. Treatment in specialised centres for spine surgery is strongly recommended, also due to the high postoperative complication rates.
Keywords
de-novo scoliosis - quality of life - multilevel fusion - last instrumented vertebra - adjacent segment degeneration
