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This article delves into the association between disc degeneration and the phenomenon of 'adding-on' in surgical outcomes post spinal fusion in adolescents with idiopathic scoliosis.
Understanding this association is crucial as it may guide future surgical decisions and possibly improve long-term outcomes in treating adolescent idiopathic scoliosis.
Research has shown a significant association between disc degeneration in distal unfused segments and the occurrence of adding-on in patients with Lenke 3C, 5C, and 6C adolescent idiopathic scoliosis post spinal fusion surgery. This study uses retrospective data to evaluate the frequency of these outcomes and their implication on patient health over a two-year follow-up period. Findings demonstrate a considerable rate of degeneration, particularly in the L5-S1 disc, correlating with poorer structural outcomes, though not significantly altering clinical scores as per VAS or SRS-22 assessments.
Disc degeneration is a significant parameter to monitor after spinal fusion for scoliosis.
The study conducted by Ketenci et al. focused on the relationship between disc degeneration (DD) in distal unfused segments and surgical outcomes in adolescent idiopathic scoliosis (AIS) patients. The researchers examined data from 47 patients who underwent long segment thoracolumbar fusion.
According to Ismail Emre Ketenci, 'The frequency of AO was found to be 29.78%, which shows a noteworthy trend in these patients.'
This finding suggests that disc degeneration is prevalent in patients following spinal fusion surgery for AIS and warrants more attention in follow-up care.
The occurrence of adding-on impacts structural outcomes post-surgery but not clinical scores.
Adding-on is associated with higher Pfirrmann scores in the L5-S1 discs of AIS patients post-fusion.
Adding-on refers to the progression of scoliosis curves beyond the initial spinal fusion segments. The study found that patients with adding-on showed significantly higher Pfirrmann grades in the L5-S1 disc.
'In the AO group, there was a statistically significant higher Pfirrmann grade of the L5-S1 disc than the Non-AO group,' noted the researchers.
Despite these structural changes, there was no significant impact on patients' clinical scores as measured by the visual analog scale and Scoliosis Research Society-22 questionnaire, highlighting a complex relationship between structural integrity and subjective well-being.
Understanding structural outcomes can refine surgical approaches and patient care post-fusion.
Though disc degeneration presents structural challenges, its effect on clinical outcomes remains limited.
The study highlights that while structural disc changes are apparent post-fusion, they do not necessarily translate to worse clinical scores. This disconnect prompts further investigation into the factors influencing long-term health and quality of life in AIS patients post-fusion.
Future research could explore how mitigating structural changes like disc degeneration might lead to improved holistic outcomes, potentially offering new therapeutic targets or surgical techniques to enhance patient care in scoliosis treatment.
Ketenci IE, Yanik HS, Marasli MK, Erdem S. Disc degeneration in distal unfused segments: cause or consequence of adding-on after posterior fusion of lenke 3c, 5c, 6c adolescent idiopathic scoliosis? Acta Neurochir (Wien). 2025;167(1):45-56. doi:10.1007/s00701-024-06412-4.
Akazawa T, Kotani T, Sakuma T, Minami S. Spinal alignments of residual lumbar curve affect disc degeneration after spinal fusion in patients with adolescent idiopathic scoliosis: follow-up after 5 or more years. Spine Surg Relat Res. 2020;4(1):50-56. doi:10.22603/ssrr.2019-0048.
Chiu CK, Tan CS, Chung WH. Mid-long-term outcome and degeneration of the remaining unfused lumbar intervertebral disc in adolescent idiopathic scoliosis patients who had posterior spinal fusion surgery. Eur Spine J. 2021;30(9):1978-1987. doi:10.1007/s00586-021-06874-5.