关键词: 脊柱侧凸, 腰椎, 椎间盘退行性变, 外科手术, 治疗结果

Abstract:

Objective： To evaluate the over 5-year follow-up clinical outcomes of degenerative lumbar scoliosis treated with operation of decompression and fusion, and the effectiveness and risks factors about revision surgery cases. Methods: A total of 47 cases of diagnosis of degenerative lumbar scoliosis treated with posterior decompression and instrument fusion recorded from Jun. 2003 to Jun. 2008 were analyzed. Lumbar Japanese Orthopedic Association (JOA) score and visual analogue score (VAS) were applied to evaluate the improvement of the clinical effect after surgery treatment, and the clinical effect and reasons of revising operation were recorded and analyzed. Results: All the 47 patients had finished the over 5-year followed-up time with an average time of (8.2±3.6) years (range from 5.2 years to 12.5 years). The patient’s mean age was (67.0±9.6) years and the age of patient range from 56 years to 81 years. There were 10 patients who underwent revision surgery since primary operation, in whom 8 cases because of proximal failure of internal fixation and the other 2 cases because of distal failure of fusion segment. The average clinical improvement excellent rate was 83.3% after 5 years since primary operation of 37 cases while the average fine rate of revision operation was 67.6%. Conclusion: In the over 5-year follow-up, there was a better clinical outcome of degenerative lumbar scoliosis treated with posterior decompression and instrumented fusion, which had a certain rate of revision operation and had a worse effect of clinical results compared with primary operation. The risks of revision surgery included the poor bone quality of patients, with fusion to L1 at proximal terminal and the fusion end to S1 at distal terminal.

Key words: Scoliosis, Lumbar vertebrae, Intervertebral disc degeneration, Surgical procedures, operative, Treatment outcome