Outcomes and complications of long segment and short segment fixation in the treatment of degenerative scoliosis: a Meta-analysis

English Keywords:Degenerative scoliosis  Internal fixation  Long segment  Short segment  Meta-analysis

English Abstract:

  【Abstract】 Objectives: Meta-analysis was used to compare and evaluate the benefits and risks of long segment internal fixation fusion and short segment internal fixation fusion for the treatment of degenerative scoliosis(DS). Methods: Literature related to long-term and short-term internal fixation fusion therapy for degeneration from CNKI, Wanfang Database, VIP, CBM, Embase, PubMed, Web of Science and Cochrane Library, including randomized controlled trials and cohort studies, were collected. The retrieval time was from inception to October 2020. Authoritative journals such as China Orthopedics Journal, Euro Spine, Chinese Journal of Spine and Spinal Cord and relevant conference proceedings, and followed up relevant references were manually consulted. Extraction from the literature included operation time, intraoperative blood loss, length of hospital stay, Cobb angle improvement, visual analogue scale(VAS) score, Oswestry disability index(ODI), postoperative complications. The included studies were analyzed using RevMan 5.3 software. Results: In the end, 29 references were included, including 9 in English and 20 in Chinese, with a total of 1,982 patients, including 956 patients with long segment fixation and 1026 patients with short segment fixation. The short segment group was superior to the long segment group in terms of operation time[WMD(weighted mean difference)=2.30, 95%CI: 1.84, 2.76, P<0.00001], intraoperative blood loss(WMD=4.05, 95%CI: 3.20, 4.89, P<0.00001), intraoperative massive hemorrhage[RR(risk ratio)=3.61, 95%CI: 1.13,11.58, P<0.05], and was associated with a small incidence of postoperative complications(RR=2.02, 95%CI: 1.42, 2.88, P<0.0001). However, the long segment group had more advantages in correcting Cobb angle[SMD(standard mean difference)=2.26, 95%CI: 3.20, 4.89, P<0.0001], rebuilding coronalbalance(WMD=7.04, 95%CI: 3.42, 10.67, P=0.0001) and sagittal balance(WMD=6.63, 95%CI: 1.47, 11.79, P<0.05), and improving ODI(WMD=-2.66, 95%CI: -3.90, -1.42, P=0.0004), and the differences were statistically significant(P<0.05); There was no significant difference in VAS between the two groups(P>0.05). Conclusions: Compared with the short segment internal fixation, the long segment internal fixation is more effective in correcting malformations and restoring spinal balance. However, the short segment internal fixation is associated with fewer complications, and it is also effective in relieving pain and neurological sign. Therefore, it′s necessary to consider the symptoms of different patients, as well as the degrees of deformity and the imbalance of coronal and sagittal planes comprehensively when deciding surgical procedures.