[Comparison of the efficacy between short-segment instrumentation and simple decompression in the treatment of degenerative lumbar scoliosis with lumbar spinal stenosis and a coronal Cobb angle<20°].

Objective

To investigate the differences in imaging and clinical efficacy between simple decompression and short-segment internal fixation in the treatment of patients with degenerative scoliosis accompanied by lumbar spinal stenosis with a coronal Cobb angle<20°.

Methods

A retrospective analysis was conducted on 80 patients diagnosed with degenerative scoliosis complicated by coronal deformity who were admitted to the Department of Spinal Surgery, Tianjin Union Medical Center, between January 2019 and October 2024. According to the surgical approaches, the patients were divided into two groups: the short-segment fixation group (fixation segments≤3) and the simple decompression group (1-2 segments decompressed). For both groups, the following parameters were recorded respectively: gender, age, disease duration, operation time, intraoperative blood loss, length of hospital stay, surgical expenses, American Society of Anesthesiologists (ASA) score, preoperative and postoperative visual analog scale (VAS) scores for low back pain and leg pain, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) low back pain score, intraoperative complications, as well as preoperative and postoperative spinopelvic parameters. The spinopelvic parameters included coronal Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Surgical complications were recorded too, included wound infection, cerebrospinal fluid leakage, pneumonia, cardio-cerebrovascular events, and junctional fusion failure.

Results

A total of 80 patients were enrolled, including 45 males and 35 females, with an age of (65.4±8.1) years. There were no significant differences in age, gender, body mass index (BMI), or ASA scores between the two groups before the operation (all P>0.05). The short-segment fixation group exhibited significantly longer operation time, greater intraoperative blood loss, more intraoperative fluoroscopy times, and higher total hospitalization costs compared with the simple decompression group (all P<0.05). At the 1-year follow-up, the low back pain VAS-B score, leg pain VAS-L score, JOA score, and ODI were significantly improved in both groups compared with preoperative values (all P<0.001). At the 1-year follow-up, the VAS-B score was (2.2±0.7) points in the short-segment group and (2.9±1.1) points in the simple decompression group (P<0.001), whereas no significant intergroup differences were observed in VAS-L, JOA score, or ODI index (all P>0.05). Compared with preoperative values, at 1 year postoperatively, the short-segment group showed decreased SVA and increased SS, LL, and PT (all P<0.001), while the simple decompression group showed decreased SVA and significantly increased PT and SS (all P<0.001). At the 1-year follow-up, the TK value was 21.8°±9.9° and 29.3°±10.8° in the short-segment group and the simple decompression group, respectively, and the PT values was 22.4°±3.8° and 26.8°±5.9°, respectively (both P<0.001), whereas no significant differences was detected in SS, PI, or LL between the two groups (all P>0.05). There was no significant differences in incidence of complication between the two groups (P=0.134).

Conclusions

The clinical efficacy of simple decompression for degenerative scoliosis accompanied by lumbar spinal stenosis with a coronal Cobb angle<20° is similar to that of short-segment internal fixation. And simple decompression, with its shorter operative time and less blood loss, serves as a viable alternative for patients who wish to minimize surgical trauma or who have significant comorbidities.