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19.02.2024 | Review Article

Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis

verfasst von: Jesús Burgos, Eduardo Hevia, Ignacio Sanpera, Vicente García, María Teresa de Santos Moreno, Gonzalo Mariscal, Carlos Barrios

Erschienen in: European Spine Journal | Ausgabe 4/2024

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Abstract

Purpose

The objective of this meta-analysis was to determine the incidence of disc degeneration in patients with surgically treated adolescent idiopathic scoliosis (AIS) and identify the associated risk factors.

Methods

PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched. The outcomes of interest were the incidence of disc degeneration, SRS-22, and radiological risk factors. The lower instrumented vertebra (LIV) was also evaluated. Fixed effects were used if there was no evidence of heterogeneity. Statistical analysis was performed using Review Manager.

Results

A meta-analysis was conducted including nine studies with a total of 565 patients. The analysis revealed that the global incidence of intervertebral disc degeneration in patients with surgically treated AIS patients was 24.78% (95% CI 16.59–32.98%) 10 years after surgery, which significantly increased to 32.32% (95% CI 21.16–43.47% at an average of 13.8 years after surgery. Among patients with significant degenerative disc changes, the SRS-22 functional, self-image, and satisfaction domains showed significantly worse results (MD − 0.25, 95% CI − 0.44 to − 0.05; MD − 0.50, 95% CI − 0.75 to − 0.25; and MD − 0.34, 95% CI − 0.66 to − 0.03, respectively). Furthermore, instrumentation at or above the L3 level was associated with a lower incidence of intervertebral disc degeneration compared to instrumentation below the L3 level (OR 0.25, 95% CI 0.10–0.64). It was also found that the preoperative and final follow-up lumbar curve magnitudes (MD 8.11, 95% CI 3.82–12.41) as well as preoperative and final follow-up lumbar lordosis (MD 0.42, 95% CI − 3.81 to 4.65) were associated with adjacent disc degeneration.

Conclusions

This meta-analysis demonstrated that the incidence of intervertebral disc degeneration significantly increased with long-term follow-up using fusion techniques, reaching up to 32% when patients were 28 years of age. Incomplete correction of deformity and fusion of levels below L3, were identified as negative prognostic factors. Furthermore, patients with disc degeneration showed worse functional outcomes.

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Titel: Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis
verfasst von: Jesús Burgos
Eduardo Hevia
Ignacio Sanpera
Vicente García
María Teresa de Santos Moreno
Gonzalo Mariscal
Carlos Barrios
Publikationsdatum: 19.02.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 4/2024
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-024-08165-1

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Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis