Short Limited Fusion Versus Long Fusion With Deformity Correction for Spinal Stenosis With Balanced De Novo Degenerative Lumbar Scoliosis: A Meta-analysis of Direct Comparative Studies.

STUDY DESIGN: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to identify advantages and disadvantages of long versus short fusion for patients with Spinal stenosis with Balanced de novo degenerative lumbar Scoliosis without substantial Sagittal imbalance (SBSS), and to determine whether short fusions and long fusions have different curve progression after surgeries and differences in operative characteristics.

SUMMARY OF BACKGROUND DATA: Patients with SBSS usually undergo short limited fusion or long fusion with curve correction. There is debate regarding whether short fusion is insufficient for SBSS for prevention scoliosis progression.

METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was performed to find studies assessing the comparison of surgical techniques for SBSS. We included all direct comparative studies comparing short and long fusion and extracted data about scoliosis progression, changes in the Oswestry Disability Index (ODI), perioperative outcomes, and complication rates. A meta-analysis was performed to calculate weighted mean differences (WMDs) and 95% confidence intervals (CIs).

RESULTS: We included data from six studies involving 362 patients (short fusion, 202 patients; long fusion, 160 patients). Both the short fusion and the long fusion groups showed decreased Cobb angle (short, 22.38°-11.69°; long, 30.74°-12.77°) and C7 plumb at the final follow-up. The long fusion group showed a substantial decrease in Cobb angle (WMD, 8.94; 95% CI, 2.55-15.33) and in C7 plumb (WMD, 5.90; 95% CI, -0.39-12.18), compared to the short fusion group. At final follow-up, ODI had decreased similarly in both groups (WMD, 1.70; 95% CI, -13.04-9.65). The short fusion group showed advantages including decreased blood loss (mean difference, 739.9 mL) and shorter operative time (mean difference, 68.0 minutes) compared to the long fusion group.

CONCLUSION: Short fusion may be a reasonable option for patients with SBSS and at low risk for curve progression.

LEVEL OF EVIDENCE: 1.