Effectiveness of Short-Segment Fixation versus Long-Segment Fixation for Degenerative Scoliosis with Cobb Angle 20°~40°: A Retrospective Observational Study

Abstract

Background There remains a great deal of controversy regarding the selection of long-segment fixation and short-segment fixation, especially for degenerative scoliosis (DS) patients with Cobb angle 20°~40°. The purpose of this study was to investigate the effects of different fixation levels in DS patients with Cobb angle 20°~40°. Material/Methods We enrolled 96 DS patients, divided into a long-segment fixation group (>3 segments) and a short-segment fixation group (≤3 segments). The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes. The spinal-pelvic parameters and complications were also collected and analyzed. Results The short-segment fixation group had the advantages of less blood loss, shorter operation time and shorter fluoroscopy time (P<0.05). The 2 groups achieved similar effects in leg pain (VAS) and ODI after operation (P>0.05); however, there was a better relief of low back pain in the long-segment fixation group (P<0.05 ) . The changes of Cobb angle, sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS) in the long-segment fixation group were more obvious than that in the short-segment fixation group at the final follow-up (P<0.05). The prevalence of complications in the long-segment fixation group was significantly higher than in the short-segment fixation group (P<0.01). Conclusions Short-segment fixation has less surgical trauma and fewer complications, whereas long-segment fixation has more advantages in improving spine-pelvis parameters and relieving low back pain.

Efficacy and Safety of Posterior Long-Segment Fixation Versus Posterior Short-Segment Fixation for Kummell Disease: A Meta-Analysis

“…For the maintenance of the local kyphosis angle, many scholars also believe that long-segment spinal internal fixation has more advantages. 24,30 Our study showed that LSF was more effective in maintaining spinal stability than SSF at the last follow-up.…”

Effect of different lumbar–iliac fixation and sacral slope for Tile C1.3 pelvic fractures: a biomechanical study

“…In the view of the principle of treatment of spinal fractures, both the upper and lower two segments of the fractured segment should be fixed to improve the reduction effect on the fracture and to minimize axial rotational motion. However, short fixation can surprisingly provide better stability and clinical efficacy than long fixation according to previous reports [ 30 , 31 ]. The primary role of ULIF is to resist separation of the fractured posterior pelvic ring, which may explain the lack of stability-gaining effect of fixation extending to L4.…”

Nonaccidental Trauma Managed with Open Spinal Fixation and Instrumentation and a Review of the Literature

“…12 There is scant evidence of whether short- versus long-segment instrumentation and fixation is preferable in the pediatric population, and a comparative study by Li et al suggest advantages to either approach. 13 For example, short-segment fixation leads to reduced blood loss and shorter intraoperative times, while long-segment instrumentation and fixation provided relief of low back pain and improved spinal-pelvic parameters. 13 A risk-benefit analysis in select pediatric patients should be performed to weigh the increased risk for operative complications to improve objective spinal-pelvic parameters in long-segment instrumentation versus less surgical trauma and the potential for fewer complications in short-segment fixation.…”