'Disc degeneration in distal unfused segments: cause or consequence of adding-on after posterior fusion of lenke 3c, 5c, 6c adolescent idiopathic scoliosis?'.

Ketenci, Ismail Emre; Yanik, Hakan Serhat; Marasli, Mert Kahraman; Erdem, Sevki

Background: The aim of this study is to examine the association between adding-on (AO) and disc degeneration(DD) of distal unfused levels in Lenke 3 C, 5 C, 6 C adolescent idiopathic scoliosis (AIS) patients with a follow-up of at least two years by comparing preoperative and postoperative magnetic resonance imaging (MRI). Methods: 47 AIS patients (32 females and 15 males) with structural thoracolumbar/lumbar (TL/L) curves treated with long segment thoracolumbar fusion were retrospectively evaluated. Patients were divided into two groups according to the occurrence of the AO (AO and Non-AO groups). The unfused discs were graded using the MRI images according to the Pfirrmann grading method. The Scoliosis Research Society-22 (SRS-22) questionnaire and Visuel Analog Scale (VAS) were used to determine clinical outcomes. Results: The frequency of AO was found to be 29.78%. Postoperative total Pfirrmann score was significantly associated with AO. L5-S1 disc in the AO group had a statistically significant higher Pfirrmann grade than the Non-AO group. No significant association was found between the VAS and SRS-22 scores related to AO, DD or other radiological outcomes. Conclusion: Although patients with AO demonstrated higher postoperative Pfirmann scores, no impact on clinical scores was observed. Furthermore, patients with AO developed significantly higher DD in L5-S1 disc, even if it is not the segment adjacent to the fusion. L5-S1 disc, which is already susceptible to degeneration, was further compromised in the presence of AO.

ADOLESCENT idiopathic scoliosis; MAGNETIC resonance imaging; MEDICAL sciences; SCOLIOSIS; TREATMENT effectiveness

Acta Neurochirurgica, 2025, Vol 167, Issue 1, p1

0001-6268

Academic Journal

10.1007/s00701-024-06412-4