• Tsutomu Akazawa, Tasuku Umehara, Masahiro Iinuma, Kota Asano, Shingo Kuroya, Yoshiaki Torii, Kenichi Murakami, Toshiaki Kotani, Tsuyoshi Sakuma, Shohei Minami, Sumihisa Orita, Kazuhide Inage, Yasuhiro Shiga, Junichi Nakamura, Gen Inoue, Masayuki Miyagi, Wataru Saito, Yawara Eguchi, Kazuki Fujimoto, Hiroshi Takahashi, Seiji Ohtori, and Hisateru Niki.
• Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
• Spine Surg Relat Res. 2020 Jan 1; 4 (1): 50-56.

IntroductionDespite preserving lumbar disc mobility, spinal sagittal, and/or coronal alignment might ultimately impede surgical success. The purpose of this study was to elucidate the effects of spinal alignment on lumbar disc degeneration after 5 or more years in adolescent idiopathic scoliosis (AIS) patients who underwent spinal fusion.MethodsSubjects were 49 AIS patients who underwent posterior spinal fusion without lumbar curve fusion. The inclusion criteria were the following: 1) Lenke type 1A, 1B, 2A or 2B, 2) age 10 to 19 years at the time of operation, and 3) minimum 5-year follow-up. The exclusion criteria were the following: 1) diagnosed as other than AIS, 2) history of lumbar disc herniation and spondylolysis, 3) subsequent surgery, and 4) history of surgery before AIS surgery. Nineteen patients agreed to participate in this research. X-rays, lumbar MRI, and questionnaires were evaluated. Disc degeneration in non-fused segments was defined as Pfirrmann grade 3 or higher. Patients with disc degenerations at the final observation (DD[+] group) were compared to those without disc degenerations (DD[-] group).ResultsThere were no significant differences in the preoperative or postoperative 1-week X-ray parameters between both groups. The lumbar curve was significantly larger in the DD[+] group compared with the DD[-] group at the final observation (DD[+]: 16.8 degrees, DD[-]: 10.4 degrees, p = 0.035). The sagittal vertical axis (SVA) was significantly larger in the DD[+] group compared with the DD[-] group at the final observation (DD[+]: -4.4 mm, DD[-]: -34.3 mm, p = 0.006). SRS-22 function, self-image, and satisfaction scores were lower in the DD [+] group compared with the DD[-] group at the final observation.ConclusionsThe patients with DD had significantly larger lumbar curve and SVA with lower SRS-22 function, self-image, and satisfaction scores at the final observation. Even though the non-fused segments were preserved, spinal alignments of non-fused lumbar curve affect the DDs.Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research.

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