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Single-Segment Spinal Decompression and Fusion With Selective Nerve Root Block in Adult Degenerative Scoliosis: A
Haoning Ma1, Sizheng Zhan1, Xiangsheng Tang1
1Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China.
Objective:
Adult degenerative scoliosis (ADS) presents a therapeutic dilemma between achieving adequate neural decompression and avoiding the morbidity associated with long-segment fusion. This study aimed to compare clinical outcomes of patients diagnosed with ADS undergoing single-segment posterior lumbar interbody fusion (PLIF) with selective nerve root block (SNRB) versus long-segment PLIF.
Methods:
A retrospective cohort study was conducted of patients with ADS undergoing elective spinal fusion at a single medical center from July2019 to December 2021. Cohorts were divided into single-segment PLIF with SNRB (SS-PLIF+SNRB) or long-segment (≥ 3) PLIF (LS-PLIF) groups. The preoperative and postoperative spinal pelvic parameters were measured using X-rays. Clinical symptoms were measured using the Oswestry Disability Index (ODI) and a visual analog scale (VAS). The patients' quality of life was evaluated using Short Form-12. Length of stay, postoperative complications, and revision surgery were recorded. Continuous variables were analyzed using Student's t-test or Mann-Whitney U test as appropriate, while categorical variables were compared using chi-squared or Fisher's exact tests.
Results:
A total of 87 patients (32 single, 55 long) were included. There were no significant differences in age, gender, BMI, preoperative spinal pelvic parameters, or preoperative clinical symptoms between the groups (p > 0.05). Patients in the SS-PLIF+SNRB group had a shorter hospital stay (p < 0.01) and a lower revision surgery rate (p < 0.01). No significant differences were noted in postoperative complications (p > 0.05). Patients in the SS-PLIF+SNRB group had better improvements in ODI and SF-12 scores 6 months after surgeries, and no significant differences were found in all clinical outcomes at the final follow-up.
Conclusion:
Single-segment PLIF with SNRB can achieve the same efficacy as a long-segment PLIF for treating ADS. Single-segment PLIF with SNRB in appropriately selected patients may provide satisfactory improvements in ODI, SF-12, and VAS leg score and mitigate hospital length of stay and revision surgery rates.