title: Selective Thoracic Fusion Provides Similar Health-Related Quality of Life but Can Cause More Lumbar Disc and Facet Joint Degeneration: A Comparison of Adolescent Idiopathic Scoliosis Patients With Normal Population 10 Years After Surgery.
abstract: OBJECTIVE
  To evaluate the long-term behavior of the lumbar curve in patients with adolescent idiopathic scoliosis treated with selective thoracic fusion and to assess the clinical and radiologic outcomes in this fusion group compared with an age- and gender-matched group.
  
  
  BACKGROUND
  Selective thoracic fusion for the treatment of adolescent idiopathic scoliosis (AIS) preserves lumbar motion segments but leaves a residual deformity. By avoiding fusion of the lumbar spine, a greater mobility may be preserved, which may be an advantage in long-term follow-up in terms of degenerative changes in unfused segments.
  
  
  METHODS
  Group A included 25 AIS patients with mean a age of 23.8 years and a mean 11.4 years of follow-up. Group B included 30 age- and gender-matched subjects without any deformity. Preoperative, postoperative, and follow-up radiographs were reviewed. All patients had MRIs taken at the final follow-up in order to evaluate disc degeneration (DD) and facet joint degeneration (FJD) at the unfused lumbar spine. Clinical evaluation was done by using Scoliosis Research Society-22R, Oswestry Disability Index, and numerical rating scale.
  
  
  RESULTS
  Sagittal and coronal balance and lowest instrumented vertebra disc angulation were stable over time. Mean grading of lumbar DD was 2.16 (2-4) in Group A and 1.86 (1-3) in Group B. Lumbar FJDs were 2.05 (1-4) in Group A and 1.60 (1-3) in Group B. There was significant difference between the two groups for DD except for the L4-L5 level (p = .26). FJD was significantly higher in the L1-L2 and L2-L3 levels (L1-L2, p = .002, L2-L3, p = .002) but not for the other levels. Outcome scores were similar without significant differences between the two groups (p > .05).
  
  
  CONCLUSIONS
  Selective thoracic fusion provides satisfactory outcomes at more than 10 years of follow-up. Our study demonstrated a moderate increase in the rate of disc degeneration in the unfused segments. Facet joint degeneration was significant at the upper two levels adjacent to the lowest instrumented vertebra.
authors.affiliation: Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No: 166 Sisli, 34381 Istanbul, Turkey. Electronic address: enercan@yahoo.com.
authors.forename: Meric
authors.initials: M
authors.lastname: Enercan
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul Bilim University Faculty of Medicine, Gayrettepe Mh., 34349 İstanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Kahraman
authors.affiliation: Department of Orthopaedics and Traumatology, Adnan Menderes University Faculty of Medicine, Merkez Kampusu Aytepe Mevkii, 09100 Aydin, Turkey.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Cobanoglu
authors.affiliation: Department of Orthopaedics and Traumatology, Erzurum Ataturk University Faculty of Medicine, Vani Efendi Mah.Yakutiye, 2540 Erzurum, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Yilar
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul Bilim University Faculty of Medicine, Gayrettepe Mh., 34349 İstanbul, Turkey.
authors.forename: Bahadir Huseyin
authors.initials: BH
authors.lastname: Gokcen
authors.affiliation: Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No: 166 Sisli, 34381 Istanbul, Turkey.
authors.forename: Selhan
authors.initials: S
authors.lastname: Karadereler
authors.affiliation: Department of Radiology, Florence Nightingale Hospital, Göktürk Merkez Mh., Göktürk Cd. No:25/A Bl., 34077 Eyüp, İstanbul, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Mutlu
authors.affiliation: Department of Radiology, Florence Nightingale Hospital, Göktürk Merkez Mh., Göktürk Cd. No:25/A Bl., 34077 Eyüp, İstanbul, Turkey.
authors.forename: Levent Onur
authors.initials: LO
authors.lastname: Ulusoy
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul Bilim University Faculty of Medicine, Gayrettepe Mh., 34349 İstanbul, Turkey.
authors.forename: Cagatay
authors.initials: C
authors.lastname: Ozturk
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul Bilim University Faculty of Medicine, Gayrettepe Mh., 34349 İstanbul, Turkey.
authors.forename: Erden
authors.initials: E
authors.lastname: Erturer
authors.affiliation: Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No: 166 Sisli, 34381 Istanbul, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Gebes
authors.affiliation: Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No: 166 Sisli, 34381 Istanbul, Turkey.
authors.forename: Tunay
authors.initials: T
authors.lastname: Sanli
authors.affiliation: Department of Orthopaedics and Traumatology, Acibadem University Faculty of Medicine, Kayisdagi Cd. No:32 34755 Atasehir Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alanay
authors.affiliation: Istanbul Spine Center, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No: 166 Sisli, 34381 Istanbul, Turkey.
authors.forename: Azmi
authors.initials: A
authors.lastname: Hamzaoglu
keywords: Adolescent idiopathic scoliosis; Disc degeneration; Facet degeneration; Long-term follow-up; Selective thoracic fusion