Determining the Magnitude of Surgery in Patients With Adult Scoliosis: A Systematic Review of the Role of Limited Fusions.

Study DesignSystematic reviewObjectiveThe role of limited fusions compared with extensive reconstructions of the spine has not been well defined. The objective of this study is to review the current literature and provide evidence-based recommendations regarding the magnitude of surgery for patients with adult scoliosis, including indications and limitations of short-segment (≤3 levels) fusions.MethodsA systematic review of the literature was conducted using PubMed/MEDLINE, Cochrane Library, Ovid and Google-Scholar using the following terms: "adult spinal deformity", "adult scoliosis", "degenerative scoliosis", "scoliosis" together with "spinal fusion", "spinal instrumentation" and "fusion". Inclusion criteria were comparative studies comprised of thoraco-lumbar or lumbo-sacral adult scoliosis treated with short- or long-segment fusion. Other types of deformities were excluded.ResultsOf the 1736 articles identified from initial query, 9 studies comprised of 660 patients with adult scoliosis who underwent a short-segment fusion (SSF, n = 366) or a long-segment fusion (LSF, n = 294) were included and analyzed for clinical and radiographic outcomes. Summative results indicate that patients undergoing SSF have lower complication rates (.21 vs .36 complications/patient), lower revision rates (9% vs 28%), and though LSF patients had greater scoliotic curvatures and sagittal imbalance at baseline, both groups had significant clinical improvement after surgery. However, the heterogeneous nature of the published data calls into question the reliability of these summative results.ConclusionsJudicious use of SSF can achieve satisfactory clinical outcomes in carefully-selected patients with adult scoliosis. Factors to consider when selecting patients for SSF include predominant symptoms, patient expectations, comorbidities and spino-pelvic parameters.