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Z Orthop Unfall
DOI: 10.1055/a-2546-7316
Review

Quality of Life after Multisegmental Fusion Surgery for Degenerative Spine Diseases

Article in several languages: English | deutsch
Frank Beyer
1   Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Porz am Rhein gGmbH, Köln, Germany (Ringgold ID: RIN39825)
,
Johanna Schirmer
2   Medizinische Fakultät, Universität zu Köln, Köln, Germany (Ringgold ID: RIN61059)
,
Tobias Prasse
3   Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Germany (Ringgold ID: RIN249152)
,
Peer Eysel
3   Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Uniklinik Köln, Köln, Germany (Ringgold ID: RIN249152)
,
Jan Bredow
1   Klinik für Orthopädie und Unfallchirurgie, Krankenhaus Porz am Rhein gGmbH, Köln, Germany (Ringgold ID: RIN39825)
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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


Publication History

Received: 03 January 2025

Accepted after revision: 25 February 2025

Article published online:
08 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Aebi M. The adult scoliosis. Eur Spine J 2005; 14: 925-948
    CrossrefPubMedSearch in Google Scholar
  • 2 Quante M. Die adulte lumbale de-novo-Skoliose. Arthritis Rheum 2016; 36: 109-114
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Pritchett JW, Bortel DT. Degenerative symptomatic lumbar scoliosis. Spine (Phila Pa 1976) 1993; 18: 700-703
    CrossrefPubMedSearch in Google Scholar
  • 4 Marty-Poumarat C, Scattin L, Marpeau M. et al. Natural history of progressive adult scoliosis. Spine (Phila Pa 1976) 2007; 32: 1227-1234
    CrossrefPubMedSearch in Google Scholar
  • 5 Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 2007; 7: 428-436
    CrossrefPubMedSearch in Google Scholar
  • 6 Liu C, Hu FQ, Hu WH. et al. Compensatory Mechanism of Maintaining the Sagittal Balance in Degenerative Lumbar Scoliosis Patients with Different Pelvic Incidence. Orthop Surg 2020; 12: 1685-1692
    CrossrefPubMedSearch in Google Scholar
  • 7 de Reuver S, van der Linden PP, Kruyt MC. et al. The role of sagittal pelvic morphology in the development of adult degenerative scoliosis. Eur Spine J 2021; 30: 2467-2472
    CrossrefPubMedSearch in Google Scholar
  • 8 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg 2021; 88
    CrossrefPubMedSearch in Google Scholar
  • 9 Wells G, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013 Accessed March 11, 2025 at: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    PubMedSearch in Google Scholar
  • 10 Arima H, Hasegawa T, Yamato Y. et al. Clinical Outcomes of Corrective Fusion Surgery From the Thoracic Spine to the Pelvis for Adult Spinal Deformity at 1, 2, and 5 years Postoperatively. Spine (Phila Pa 1976) 2022; 47: 792-799
    CrossrefPubMedSearch in Google Scholar
  • 11 Buell TJ, Smith JS, Shaffrey CI. et al. Operative Treatment of Severe Scoliosis in Symptomatic Adults: Multicenter Assessment of Outcomes and Complications With Minimum 2-Year Follow-up. Neurosurg 2021; 89: 1012-1026
    CrossrefPubMedSearch in Google Scholar
  • 12 Cho KJ, Suk SI, Park SR. et al. Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis. Eur Spine J 2009; 18: 531-537
    CrossrefPubMedSearch in Google Scholar
  • 13 Zaborovskii N, Ptashnikov D, Mikhaylov D. et al. Spinal deformity in elderly patients: comparison of two distal termination sites of lumbar curve fusion. Eur J Orthop Surg Traumatol 2017; 27: 73-78
    CrossrefPubMedSearch in Google Scholar
  • 14 Smith JS, Lafage V, Shaffrey CI. et al. Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up. Neurosurgery 2016; 78: 851-861
    CrossrefPubMedSearch in Google Scholar
  • 15 Ha Y, Maruo K, Racine L. et al. Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae: Clinical article. J Neurosurg Spine 2013; 19: 360-369
    CrossrefPubMedSearch in Google Scholar
  • 16 Haddad S, Yasuda T, Vila-Casademunt A. et al. Revision surgery following long lumbopelvic constructs for adult spinal deformity: prospective experience from two dedicated databases. Eur Spine J 2023; 32: 1787-1799
    CrossrefPubMedSearch in Google Scholar
  • 17 Hassanzadeh H, Jain A, El Dafrawy MH. et al. Three-Column Osteotomies in the Treatment of Spinal Deformity in Adult Patients 60 Years Old and Older: Outcome and Complications. Spine (Phila Pa 1976) 2013; 38: 726-731
    CrossrefPubMedSearch in Google Scholar
  • 18 Kelly MP, Lurie JD, Yanik EL. et al. Operative Versus Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis. J Bone Joint Surg Am 2019; 101: 338-352
    CrossrefPubMedSearch in Google Scholar
  • 19 Koller H, Pfanz C, Meier O. et al. Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients. Eur Spine J 2016; 25: 532-548
    CrossrefPubMedSearch in Google Scholar
  • 20 Lertudomphonwanit T, Kelly MP, Bridwell KH. et al. Rod fracture in adult spinal deformity surgery fused to the sacrum: prevalence, risk factors, and impact on health-related quality of life in 526 patients. Spine J 2018; 25: 1612-1624
    CrossrefPubMedSearch in Google Scholar
  • 21 Li G, Passias P, Kozanek M. et al. Adult Scoliosis in Patients Over Sixty-Five Years of Age: Outcomes of Operative Versus Nonoperative Treatment at a Minimum Two-Year Follow-up. Spine 2009; 34: 2165-2170
    CrossrefPubMedSearch in Google Scholar
  • 22 Sardi JP, Lazaro B, Smith JS. et al. Rod fractures in thoracolumbar fusions to the sacrum/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective, multicenter cohort of 160 patients. J Neurosurg Spine 2022; 38: 217-229
    CrossrefPubMedSearch in Google Scholar
  • 23 Di Silvestre M, Lolli F, Bakaloudis G. Degenerative lumbar scoliosis in elderly patients: dynamic stabilization without fusion versus posterior instrumented fusion. Spine J 2014; 14: 1-10
    CrossrefPubMedSearch in Google Scholar
  • 24 Smith JS, Lafage V, Shaffrey CI. et al. Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up. Neurosurgery 2016; 78: 851-861
    CrossrefPubMedSearch in Google Scholar
  • 25 Yao YC, Kim HJ, Bannwarth M. et al. Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up. Global Spine J 2023; 13: 932-939
    CrossrefPubMedSearch in Google Scholar
  • 26 Yuan L, Li W, Zeng Y. Minimum Clinically Important Difference in Patient-reported Outcome Measures in de novo Degenerative Lumbar Scoliosis: Is it Appropriate to Apply the Values of Adult Spine Deformity?. Spine 2023; 48: 1017-1025
    CrossrefPubMedSearch in Google Scholar
  • 27 Zaborovskii N, Ptashnikov D, Mikhaylov D. et al. Spinal deformity in elderly patients: comparison of two distal termination sites of lumbar curve fusion. Eur J Orthop Surg Traumatol 2017; 27: 73-78
    CrossrefPubMedSearch in Google Scholar
  • 28 Zimmerman RM, Mohamed AS, Skolasky RL. et al. Functional Outcomes and Complications After Primary Spinal Surgery for Scoliosis in Adults Aged Forty Years or Older: A Prospective Study With Minimum Two-Year Follow-up. Spine (Phila Pa 1976) 2010; 35: 1861-1866
    CrossrefPubMedSearch in Google Scholar
  • 29 Wells G, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed March 19, 2025 at: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    PubMed
  • 30 Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000; 25: 2940-2952
    CrossrefPubMedSearch in Google Scholar
  • 31 Tonosu J, Takeshita K, Hara N. et al. The normative score and the cut-off value of the Oswestry Disability Index (ODI). Eur Spine J 2012; 21: 1596-1602
    CrossrefPubMedSearch in Google Scholar
  • 32 Transfeldt EE, Topp R, Mehbod AA. et al. Surgical Outcomes of Decompression, Decompression With Limited Fusion, and Decompression With Full Curve Fusion for Degenerative Scoliosis With Radiculopathy. Spine (Phila Pa 1976) 2010; 35: 1872-1875
    CrossrefPubMedSearch in Google Scholar
  • 33 Flouzat-Lachaniette CH, Ratte L, Poignard A. et al. Minimally invasive anterior lumbar interbody fusion for adult degenerative scoliosis with 1 or 2 dislocated levels. J Neurosurg Spine 2015; 23: 739-746
    CrossrefPubMedSearch in Google Scholar
  • 34 Putzier M, Pumberger M, Halm H. et al. Operative Therapie der degenerativen Lumbalskoliose. Orthopäde 2016; 45: 744-754
    CrossrefPubMedSearch in Google Scholar
  • 35 von Strempel A, Trenkmann S, Krönauer I. et al. The stability of bone screws in the os sacrum. Eur Spine J 1998; 7: 313-320
    CrossrefPubMedSearch in Google Scholar
  • 36 Cho KJ, Kim YT, Shin SH. et al. Surgical treatment of adult degenerative scoliosis. Asian Spine J 2014; 8: 371-381
    CrossrefPubMedSearch in Google Scholar