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Tag: adolescent|article link|lumbar disc degeneration|Scoliosis|spine fusion

Long Term MRI Follow-up Demonstrates Minimal Transitional Level Lumbar Disc Degeneration after Posterior Spine Fusion for Adolescent Idiopathic Scoliosis.

By wp_zaman

Long Term MRI Follow-up Demonstrates Minimal Transitional Level Lumbar Disc Degeneration after Posterior Spine Fusion for Adolescent Idiopathic Scoliosis.

Spine (Phila Pa 1976). 2011 Feb 1;

Authors: Green DW, Lawhorne TW, Widmann RF, Kepler CK, Ahern C, Mintz DN, Rawlins BA, Burke SW, Boachie-Adjei O

ABSTRACT:: Study Design: Retrospective cohort studyObjective: To describe long-term clinical and imaging results focusing on the uninstrumented lumbar spine after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).Summary of Background Data: Although previous studies found rates of low back pain after long fusion for AIS which are comparable to rates found in the general population, many surgeons believe that the long lever arm associated with the fusion mass will result in increased stress at uninstrumented caudal intervertebral discs and accelerated degenerative changes.Methods: This is a retrospective chart and imaging review of AIS patients treated with posterior fusion and segmental instrumentation. Patients completed follow-up examination, outcomes questionnaires, radiographs, and MRI. MRIs were scored for evidence of degeneration of lumbar discs below the level of the fusion.Results: 20 patients participated in the study, providing 90 discs below fusions for evaluation. The average follow-up was 11.8 years. The distal level of fixation was at L1 on average. The major curve averaged 55±11 degrees preoperatively and was corrected to 25±10 degrees at follow-up.Follow-up MRI demonstrated new disc pathology in 85% of patients enrolled. Only one patient demonstrated significant degenerative disc disease at the junctional level, whereas most pathology was seen at the L5-S1 disc.The average Pfirrmann grade at uninstrumented levels deteriorated from 1.1 pre-operatively to 1.8 at follow-up. The greatest degree of degeneration was seen at the L5-S1 disc space where average degenerative scores increased from 1.2 pre-operatively to 2.3 post-operatively. Three patients with severe disc disease were taking NSAIDs for pain, but no narcotics. Only mild SRS and Oswestry changes were noted in this severe degeneration group.Conclusion: Despite demonstrating an accelerated rate of L5-S1 disc degeneration, our study group has good functional scores and maintenance of correction over ten years post-fusion. In this long-term MRI follow-up study, disc degeneration was found remote to the lowest instrumented vertebra.

PMID: 21289549 [PubMed – as supplied by publisher]