Home Medicine Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
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Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis

  • Long Pang EMAIL logo , Zhihui Gao , Long Ma , Yaping Li , Zhidong Lu , Liang Zhang , Peng Li and Long Wu
Published/Copyright: June 21, 2024
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Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

The bleeding time and amount in the short-segment group were shorter than in the long-segment group, and the bleeding volume was less than in the long-segment group. The Japanese Orthopaedic Association low back pain score, Oswestry Dysfunction Index, and lumbar spine stiffness disability index score of the two groups were significantly improved preoperatively, postoperatively, and at 6 months, 1 year, and 2 years post-operation. The differences were statistically significant at different time points within the groups. Neurological function improved to varying degrees postoperatively. The Cobb angle was significantly higher in both groups (P < 0.05). Adjacent vertebral disease occurred in 10 of 64 patients with short-segment fixation, with a prevalence of 15.6%. Preoperative pelvic tilt angle, preoperative pelvic projection angle (PPA), preoperative degree of matching of PPA to LL (PI-LL), and preoperative coronal Cobb angle were higher in patients with adjacent vertebral disease. There were varying degrees of improvement in low back pain and spinal function after short-segment decompression and fusion internal fixation. However, the patients are generally elderly and at risk of persistent low back pain and accelerated degeneration of adjacent segments.

Keywords: long-segment internal fixation; short-segment internal fixation; degenerative scoliosis; adjacent vertebral disease; coronal Cobb’s angle

1 Introduction

In recent years, with the aging population in China, the incidence of adult degenerative scoliosis (ADS) has significantly increased and continues to rise with age [1]. As the quality of life improves, more adult patients with degenerative scoliosis (DS) are opting for surgical intervention when conservative treatments fail to yield satisfactory results. Consequently, medical staff are increasingly concerned with the growing number of patients with DS seeking surgical solutions.

ADS refers to a spinal deformity that develops after skeletal maturity without a prior history of scoliosis. It is caused by the progressive degeneration of intervertebral discs, vertebral bodies, and intervertebral joints, characterized by a Cobb angle >10° on X-rays. ADS mainly occurs in the lumbar and thoracolumbar spines and is prevalent in individuals over 55 years old [2]. Patients often present with symptoms such as lower limb radiating pain, low back pain, and trunk imbalance. Studies on the pathological mechanism of ADS have found that lateral curvature, combined with spinal canal stenosis and lateral spondylolisthesis of the vertebral body, causes neurogenic claudication [3]. The nerve root on the concave side is compressed while the convex side is stretched, leading to neurological symptoms. Low back pain is primarily due to lumbar facet joint disease and intervertebral disc degeneration. Sagittal plane spine imbalance can cause lumbosacral muscle strain, further contributing to low back pain [4].

Previous studies categorized scoliosis as an abnormal transverse curvature deformity of the spine. However, with advancements in imaging technology and a deep understanding of biomechanics and spinal anatomy, it is now recognized as a three-dimensional deformity [5]. In conservative treatment, patients are typically prescribed muscle relaxants and non-steroidal anti-inflammatory drugs to manage pain [6]. If symptoms persist, treatment options such as epidural steroid injections, articular injections, nerve root blocks, and oral analgesics may be considered. Physical therapy and aquatic exercise therapy can complement drug therapy, promoting dysfunction relief and maintaining muscle tension [7]. While the efficacy of bracing in preventing lateral bending progression remains uncertain, theoretically, it can provide pain relief through its immobilizing effect. However, prolonged brace wear may lead to disuse atrophy or motor dysfunction in relevant muscles. Unfortunately, some patients experience worsening symptoms such as low back and leg pain and nerve root pain despite conservative treatment, significantly impacting their daily lives. Surgical intervention becomes necessary for patients who do not respond effectively to conservative measures.

Surgical treatment is a common method for alleviating the symptoms of patients, providing pain relief, stabilizing the spine, and correcting spinal deformities to a certain extent. In the surgical treatment of DS, the primary approach involves internal fixation, fusion, and decompression of the segment responsible for symptoms. Long- and short-segment internal fixation and fusion are commonly employed techniques. Short-segment internal fixation and fusion involve fixing the fusion segment shorter than the adjacent upper and lower vertebrae of the affected vertebral body. This typically includes one vertebra above and below the fractured vertebra. In contrast, long-segment internal fixation and fusion extend to or beyond the upper and lower vertebrae of the affected vertebral body, with fixation spanning two or more vertebrae above and below the injured segment. Researchers both domestically and internationally have found that long-segment internal fixation and fusion effectively achieve fixation, thereby enhancing spinal balance [8]. Short-segment internal fixation and fusion can stabilize the spine and alleviate symptoms when the fusion segment is short. However, there remains considerable controversy among experts and scholars worldwide regarding the preferred method of fixed treatment for DS.

Patients with DS often opt for surgical intervention primarily due to symptoms associated with lumbar stenosis, typically involving shorter spinal segments than scoliosis cases. While long-segment spinal fusion offers greater stability, it comes with drawbacks such as reduced active segments, limited spinal range of motion, increased costs, and a higher risk of perioperative complications [8]. Considering that older patients frequently present with multiple medical comorbidities, symptom relief can often be achieved through short-segment decompression fusion procedures targeting the upper and lower vertebral boundaries of the scoliosis region [9].

With an aging population, adjacent spondylosis (ASD) arises as a common complication following lumbar fusion surgery, characterized by degenerative changes in segments adjacent to the fused region, which can manifest as imaging or symptomatic ASD [10]. In this study, ASD is defined as a pathological process resulting from disc degeneration, leading to clinical symptoms such as neuroinfarct lesions, stenosis, and instability. ASD represents the most prevalent complication of short-segment fusion for DS and significantly influences reoperation rates post-fusion. Despite widespread reporting on the incidence and factors associated with ASD, inconsistencies such as varying fusion techniques and preoperative diagnoses hinder definitive conclusions. The factors contributing to ASD development remain controversial, with limited research available. Therefore, this study aims to assess the efficacy of short-segment decompression fusion for DS and explore potential factors associated with the occurrence of ASD. By doing so, it seeks to offer insights for optimizing clinical treatment planning and enhancing treatment outcomes.

2 Methods

2.1 General information

A total of 96 patients with DS admitted to our spine department from September 2018 to December 2020 were retrospectively analyzed and divided into two groups based on the number of fixed segments: 64 patients with short-segment fixation (short-segment group) and 32 patients with long-segment fixation (long-segment group) (Figure S1).

The inclusion criteria were as follows: (1) patients with a diagnosis of DS confirmed by preoperative symptoms and imaging findings, treated with posterior short-segment decompression fusion internal fixation (fusion segment limited to the upper and lower ends of the laterally curved spine); (2) patients with a follow-up period of at least 1 year; and (3) patients with complete clinical and imaging data, including preoperative full-length frontal and lateral radiographs of the spine, postoperative lateral radiographs of the lumbar spine, and magnetic resonance imaging (MRI) preoperatively and at the final follow-up.

The exclusion criteria were as follows: (1) incomplete clinical information; (2) Parkinson’s disease, neuromuscular spondylitis, juvenile idiopathic spondylitis, or secondary congenital spondylitis; (3) complicated spinal infection, tuberculosis, trauma, or tumor; (4) history of previous spinal surgery; (5) inability to cooperate with follow-up or loss of follow-up information; (6) combined spinal fracture, spinal infection, spinal tumor, or ankylosing spondylitis; (7) history of previous lumbar spine surgery; and (8) previous anterior or lateral approach fusion of the lumbar spine.

2.2 Observation methods for preoperative and postoperative follow-up

Medical history data, clinical symptoms, signs, imaging data, and curative effect evaluation indices were collected for all patients preoperatively, as well as at 3, 6, and 12 months postoperatively and at the last follow-up (Table S1). To reduce errors and increase the reliability of the results, the average value from multiple measurements was used. All data were measured three times by the same physician, and the average value was taken.

2.3 Evaluation of efficacy

Surgical outcomes were assessed using visual analogue scores (VAS) to evaluate the severity of pre- and post-operative leg and low back pain in patients [11]. The Oswestry Dysfunction Index (ODI) was used to determine the severity of the pre- and post-operative spinal dysfunction of the patients. The ODI questionnaire consists of ten questions covering pain intensity, self-care, lifting, walking, sitting, sleep disturbances, sex life, social life, and travel, with six response options for each question. The minimum ODI score is calculated as follows: (score obtained/5 × number of questions answered) × 100%. A score of 0% indicates no functional impairment, while a score of 100% indicates complete functional impairment. The improvement rate of the ODI score is calculated using the formula: improvement rate = (1 – post-operative ODI score/pre-operative ODI score) × 100%. Improvement rates are classified as follows: an improvement of ≥75% is considered excellent, 50–75% is considered good, 25–50% is considered moderate, and <25% is considered poor [12].

2.4 Influencing factors related to osteoarthritis

ASD was observed in 10 of 64 patients with short-segment fixation, who were then divided into two groups: ASD (n = 10) and NASD (n = 54). The ASD group consisted of ten patients with ASD on the cranial side (15.6%), while the NASD group consisted of 54 patients without ASD on the caudal side (84.4%). This study included possible correlates, divided into three parts: (1) demographic factors: gender, age, smoking status (present or absent), body mass index (BMI), preoperative leg pain and low back pain VAS scores, and preoperative ODI scores; (2) surgical correlates: number of fused segments, operative segments, operative time, bleeding, and whether adjacent synapses were violated during surgery; and (3) imaging parameters: anterior lumbar lordosis (LL), sacral tilt angle (SS), pelvic tilt (PT) angle, PI angle, PI–LL, distance between the L1 lead line and S1 (LASD), coronal Cobb angle, and preoperative disc degeneration in adjacent segments (graded I–V according to the Pfirrmann et al. classification system). Patients classified as having grade ≥III were considered to have degenerative changes.

2.5 Measurement of imaging parameters

Cobb angle: measured in the coronal position as the angle between the tangent lines of the upper and lower endplates; LL: defined as the angle between the tangent line of the upper endplate of L1 and that of S1; SS: determined as the angle between the horizontal line and the tangent line of the upper endplate of S1; PT: calculated as the angle between the gravitational plumb line and the line connecting the midpoint of the upper endplate of S1 to the central midpoint of the femoral heads bilaterally; PI: measured as the angle between the line from the midpoint of the upper endplate of S1 to the central midpoint of the femoral heads bilaterally and the perpendicular line through the midpoint of the S1 upper endplate; PI–LL: represents the difference between the pelvic projection angle (PPA) and the lumbar anterior convexity angle, with a positive value taken; LASD: defined as the horizontal distance between the plumb line through the center of the L1 vertebra and the posterior superior edge of S1 (a positive value indicates an anterior position of the L1 plumb line, while a negative value indicates a posterior position). ASD imaging criteria: included anterior or posterior slip >3 mm; adjacent segmental disc height loss >3 mm; intervertebral angle >5° on flexion–extension lateral views; and the presence of spinal stenosis or disc herniation at adjacent levels on follow-up MRI.

All imaging data were measured three times by the same physician, and the mean value was used for analysis.

2.6 Assessment of lumbar disc degeneration

The MRI (T2W1) grading criteria for Pfirrmann disc degeneration are shown in Table S2.

2.7 Surgical techniques

Following general anesthesia with tracheal intubation, the patient is placed in the prone position, disinfected, and draped in a sterile fashion. A conventional lumbar midline dorsal incision is made, and the paraspinal muscles are stripped down to the outer surface of the articular eminence to expose the fixed segment. The vertebral lamina and articular eminence are also exposed. Using the apex of the “human” ridge as the reference point, an opening is made, a hole is drilled, the depth is measured, and the thread is tapped. A pedicle screw of the appropriate length and thickness is placed based on the measurements. The central canal and lateral saphenous fossa are decompressed within the fixed segment. The intervertebral discs and cartilage endplates are completely removed, and the space is fused with a trimmed autogenous bone block and an intervertebral fusion device. Depending on the preoperative spinal deformity, a curved metal rod is selected to support the concave side, and appropriate pressure is applied to the convex side to correct the scoliosis deformity. If necessary, the interbody fusion device is placed on the concave side of the vertebral apex. Fluoroscopy with a C-arm X-ray machine is used to confirm the satisfactory position of the internal fixation. The incision is then sutured, and a silicone ball drain is placed, which is removed 72 h postoperatively. Antibacterial medication is administered for 1–3 days to prevent infection. A lumbar brace was worn for 3 days postoperatively, and then immobilization with the brace continued for 3 months. After this period, the brace was removed, and the patient began appropriate functional exercise.

2.8 Statistical analysis

Data for all relevant variables in this study were analyzed using IBM SPSS Statistics for Windows (version 22.0; IBM Corp., Armonk, NY, USA). Continuous variables are expressed as the mean ± standard deviation. Continuous variables such as VAS score, ODI score, age, BMI, operative time, blood loss, LL, SS, PT, PI, LASD, PI–LL, and coronal Cobb angle were analyzed using the t-test. Categorical variables, including gender, smoking status, number of fused segments, operative segments, whether adjacent synapses were violated during surgery, and preoperative adjacent segment disc degeneration grade, were analyzed using the chi-square test. Significant differences between the two groups were determined by a P-value of <0.05, while highly significant differences were determined by a P-value of <0.05.

  1. Ethical approval: The study was approved by the Ethics Committee of the General Hospital of Ningxia Medical University (No. 2017-131).

3 Results

3.1 Clinical data

There was no significant difference in age, height, weight, or BMI between the two groups (P > 0.05), as shown in Table 1.

Table 1

Comparison of preoperative basic conditions between the two groups

Short-segment group Long-segment group t P
Age 63.31 ± 7.49 64.00 ± 5.97 0.051 0.824
Height 162.19 ± 11.42 165.00 ± 8.17 0.383 0.543
Weight 68.00 ± 15.23 68.75 ± 10.71 0.015 0.902
BMI 25.78 ± 5.06 25.37 ± 4.64 0.036 0.851
Apical rotation Nash Moe 1.88 ± 0.50 2.00 ± 0.53 7.971 0.095
Cobb angle (°) 11.08 ± 5.17 11.87 ± 6.17 1.449 0.241
Coronal imbalance value (mm) 14.39 ± 3.66 16.95 ± 7.17 1.364 0.255
Lateral sliding of apical vertebra (mm) 6.54 ± 4.94 9.24 ± 7.36 1.148 0.296
Lumbar lordosis (°) 18.13 ± 12.40 23.76 ± 11.37 1.160 0.293
Sagittal imbalance value (mm) 33.83 ± 17.90 27.47 ± 13.87 0.771 0.390
Pelvic projection angle (°) 56.33 ± 9.70 62.18 ± 10.00 1.901 0.182
Pelvic inclination angle (°) 44.37 ± 7.22 42.97 ± 6.42 0.215 0.648
Sacral inclination angle (°) 42.66 ± 11.98 44.31 ± 9.41 0.115 0.738
Proximal intervertebral space height A (mm) 10.62 ± 2.25 9.09 ± 2.04 2.619 0.120
Proximal intervertebral space height B (mm) 7.28 ± 2.20 6.96 ± 1.27 0.147 0.705
Posterior diameter of proximal vertebral precursor D (mm) 41.27 ± 5.29 40.24 ± 4.20 0.231 0.636
Proximal ratio (A + B)/2/D 0.22 ± 0.06 0.33 ± 0.37 1.425 0.245

Several parameters were not statistically different between the two groups of patients preoperatively. These included apical rotation Nash Moe, Cobb angle, coronal imbalance value, lateral sliding of the apical vertebra, LL, sagittal imbalance value, PPA, pelvic inclination (PI) angle, sacral inclination angle, proximal intervertebral space heights A and B, posterior diameter of the proximal vertebral precursor D, and proximal ratio (P > 0.05). The details are shown in Table 1.

3.2 Data measurement for both groups of patients

The two groups were followed up for 6 months, 1 year, and 2 years postoperatively. There was a significant difference between the two groups in bleeding volume, operation time, length of stay, apical rotation Nash Moe, Cobb angle, coronal imbalance value, lateral sliding of the apical vertebra, sacral inclination angle, and Cobb angle of the upper and fixed vertebrae (P < 0.05), as shown in Table 2.

Table 2

Comparison of follow-up results of the two groups at 6 months, 1 year, and 2 years after operation

Short-segment group Long-segment group t P
After operation
Bleeding volume (mL) 293.75 ± 104.68 878.75 ± 711.87 3.289 <0.05
Operation time (min) 190.31 ± 53.87 264.38 ± 108.15 2.266 <0.05
Length of stay (day) 26.38 ± 8.49 30.63 ± 10.13 2.583 <0.05
Apical rotation Nash Moe 1.50 ± 0.52 1.75 ± 0.89 3.321 <0.05
Cobb angle (°) 8.12 ± 3.23 9.79 ± 4.35 6.038 <0.05
Coronal imbalance value (mm) 49.64 ± 8.98 47.67 ± 15.58 2.629 <0.05
Lateral sliding of apical vertebra (mm) 5.48 ± 2.59 7.49 ± 5.47 3.654 <0.05
Lumbar lordosis (°) 50.77 ± 12.35 50.86 ± 15.15 0.015 0.987
Sagittal imbalance value (mm) 53.31 ± 7.18 52.38 ± 7.15 6.519 <0.05
Pelvic projection angle (°) 46.46 ± 10.19 52.10 ± 8.72 5.128 <0.05
Pelvic inclination angle (°) 24.07 ± 11.96 24.89 ± 7.4 4.108 <0.05
Sacral inclination angle (°) 26.7 ± 10.13 25.97 ± 11.24 2.983 <0.05
Cobb angle of upper fixed vertebra (°) 4.94 ± 2.75 3.84 ± 4.62 14.77 <0.05
Cobb angle of lower fixed vertebra (°) 5.12 ± 2.91 3.92 ± 3.52 11.75 <0.05
Six months after operation
Apical rotation Nash Moe 1.94 ± 0.77 3.01 ± 0.93 2.998 <0.05
Cobb angle (°) 7.01 ± 4.34 7.66 ± 2.94 6.386 <0.05
Coronal imbalance value (mm) 11.27 ± 6.12 20.54 ± 8.23 3.120 <0.05
Lateral sliding of apical vertebra (mm) 9.28 ± 3.70 13.52 ± 2.64 2.881 <0.05
Lumbar lordosis (°) 31.15 ± 11.56 31.12 ± 12.21 0.005 0.995
Sagittal imbalance value (mm) 15.24 ± 2.94 35.21 ± 3.04 15.52 <0.05
Pelvic projection angle (°) 25.43 ± 9.17 40.21 ± 9.54 3.674 <0.05
Pelvic inclination angle (°) 20.54 ± 1.26 36.21 ± 10.95 5.778 <0.05
Sacral inclination angle (°) 19.25 ± 6.90 33.64 ± 8.47 4.469 <0.05
Proximal intervertebral space height A (mm) 7.56 ± 3.16 8.40 ± 4.20 0.550 0.587
Proximal intervertebral space height B (mm) 4.08 ± 2.26 5.15 ± 2.76 1.017 0.320
Posterior diameter of proximal vertebral precursor D (mm) 28.99 ± 12.12 20.53 ± 15.85 1.456 0.159
Proximal ratio (A + B)/2/D 0.44 ± 0.85 0.48 ± 0.39 0.125 0.901
Distal intervertebral space height A (mm) 9.69 ± 3.47 9.03 ± 2.16 0.489 0.629
Distal intervertebral space height B (mm) 8.51 ± 2.62 7.91 ± 4.82 0.398 0.693
Posterior diameter of distal vertebral precursor D (mm) 29.75 ± 10.69 25.43 ± 13.98 0.842 0.408
Distal ratio (A + B)/2/D 0.35 ± 0.17 0.45 ± 0.24 1.184 0.248
Cobb angle of upper fixed vertebra (°) 20.13 ± 9.44 38.23 ± 11.16 5.785 <0.05
Cobb angle of lower fixed vertebra (°) 18.21 ± 9.92 35.72 ± 6.69 4.484 <0.05
JOA low back pain score 13.13 ± 2.83 25.12 ± 2.62 18.37 <0.05
ODI score of low back pain 35.70 ± 18.07 41.10 ± 19.65 3.156 <0.05
Lumbar spine stiffness disability index score 2.01 ± 0.41 2.59 ± 0.46 3.140 <0.05
One year after operation
Apical rotation Nash Moe 1.12 ± 0.70 2.38 ± 0.74 4.081 <0.05
Cobb angle (°) 5.52 ± 3.26 6.25 ± 3.56 7.207 <0.05
Coronal imbalance value (mm) 8.61 ± 7.8 9.36 ± 7.92 3.167 <0.05
Lateral sliding of apical vertebra (mm) 6.27 ± 1.84 9.17 ± 2.16 3.439 <0.05
Lumbar lordosis (°) 49.41 ± 10.89 47.94 ± 16.75 0.260 0.797
Sagittal imbalance value (mm) 11.47 ± 9.25 18.76 ± 8.98 4.357 <0.05
Pelvic projection angle (°) 15.54 ± 6.23 25.76 ± 6.25 7.488 <0.05
Pelvic inclination angle (°) 16.48 ± 6.32 22.75 ± 13.3 4.112 <0.05
Sacral inclination angle (°) 15.32 ± 4.54 25.67 ± 5.01 5.091 <0.05
Proximal intervertebral space height A (mm) 16.68 ± 5.85 16.46 ± 6.01 0.086 0.932
Proximal intervertebral space height B (mm) 17.56 ± 7.64 17.99 ± 9.53 0.119 0.905
Posterior diameter of proximal vertebral precursor D (mm) 25.19 ± 10.55 31.67 ± 12.46 1.337 0.194
Proximal ratio (A + B)/2/D 0.81 ± 0.47 0.73 ± 0.63 0.351 0.728
Distal intervertebral space height A (mm) 12.16 ± 3.39 10.26 ± 4.04 1.216 0.237
Distal intervertebral space height B (mm) 12.41 ± 5.15 14.09 ± 5.87 0.719 0.479
Posterior diameter of distal vertebral precursor D (mm) 29.54 ± 12.61 25.86 ± 14.51 0.641 0.527
Distal ratio (A + B)/2/D 0.5 ± 0.27 0.63 ± 0.39 0.958 0.348
Cobb angle of upper fixed vertebra (°) 16.75 ± 7.69 26.24 ± 11.29 5.005 <0.05
Cobb angle of lower fixed vertebra (°) 15.35 ± 6.38 23.72 ± 9.77 5.565 <0.05
JOA low back pain score 22.32 ± 2.21 26.78 ± 2.6 4.400 <0.05
ODI score of low back pain 32.5 ± 9.44 45.12 ± 6.74 6.023 <0.05
Lumbar spine stiffness disability index score 1.56 ± 0.51 2.39 ± 0.52 3.735 <0.05
Two years after operation
Apical rotation Nash Moe 0.75 ± 0.58 1.96 ± 0.52 4.976 <0.05
Cobb angle (°) 4.37 ± 3.40 5.42 ± 4.67 6.257 <0.05
Coronal imbalance value (mm) 4.32 ± 3.73 15.53 ± 2.82 7.468 <0.05
Lateral sliding of apical vertebra (mm) 5.06 ± 0.88 7.89 ± 0.96 6.748 <0.05
Lumbar lordosis (°) 40.28 ± 11.56 42.34 ± 11.94 0.407 0.687
Sagittal imbalance value (mm) 10.23 ± 5.85 19.52 ± 5.93 3.651 <0.05
Pelvic projection angle (°) 18.52 ± 2.71 21.36 ± 3.46 5.320 <0.05
Pelvic inclination angle (°) 15.32 ± 8.39 22.75 ± 7.19 3.864 <0.05
Sacral inclination angle (°) 10.23 ± 4.34 18.24 ± 4.71 4.147 <0.05
Proximal intervertebral space height A (mm) 14.60 ± 7.97 14.31 ± 7.37 0.086 0.932
Proximal intervertebral space height B (mm) 17.84 ± 6.89 15.23 ± 7.67 0.843 0.408
Posterior diameter of proximal vertebral precursor D (mm) 22.04 ± 10.91 29.57 ± 12.38 1.526 0.141
Proximal ratio (A + B)/2/D 0.93 ± 0.57 0.67 ± 0.47 1.112 0.278
Distal intervertebral space height A (mm) 12.51 ± 4.41 11.37 ± 4.12 0.609 0.548
Distal intervertebral space height B (mm) 12.70 ± 5.63 10.25 ± 6.18 0.973 0.340
Posterior diameter of distal vertebral precursor D (mm) 30.74 ± 9.15 30.63 ± 11.15 0.025 0.979
Distal ratio (A + B)/2/D 0.43 ± 0.14 0.40 ± 0.18 0.450 0.656
Cobb angle of upper fixed vertebra (°) 15.26 ± 6.30 12.75 ± 6.39 5.287 <0.05
Cobb angle of lower fixed vertebra (°) 14.67 ± 5.21 9.31 ± 10.64 4.579 <0.05
JOA low back pain score 18.21 ± 2.42 5.73 ± 2.51 7.091 <0.05
ODI score of low back pain 7.65 ± 3.51 6.13 ± 4.16 5.252 <0.05
Lumbar spine stiffness disability index score 1.50 ± 0.52 3.65 ± 0.74 8.291 <0.05

Six months postoperatively, there was a significant difference between the two groups in apical rotation Nash Moe, Cobb angle, coronal imbalance value, lateral sliding of the apical vertebra, sacral inclination angle, Cobb angle of the upper and lower fixed vertebrae, Japanese Orthopaedic Association (JOA) and ODI low back pain scores, and lumbar spine stiffness disability index score (P < 0.05), as shown in Table 2.

One year postoperatively, there was a significant difference between the two groups in apical rotation Nash Moe, Cobb angle, coronal imbalance value, lateral sliding of the apical vertebra, sacral inclination angle, Cobb angle of the upper and lower fixed vertebrae, JOA and ODI low back pain scores, and lumbar spine stiffness disability index score (P < 0.05), as shown in Table 2.

Two years postoperatively, there was a significant difference between the two groups in apical rotation Nash Moe, Cobb angle, coronal imbalance value, lateral sliding of the apical vertebra, sacral inclination angle, Cobb angle of the upper and lower fixed vertebrae, JOA and ODI low back pain scores, and lumbar spine stiffness disability index score (P < 0.05), as shown in Table 2.

A comparison of treatment effects in patients in the short-segment group preoperatively and 6 months postoperatively revealed significant differences in coronal imbalance value, LL, lateral sliding of the apical vertebra, sacral inclination angle, proximal intervertebral space heights A and B, posterior diameter of the proximal and distal vertebral precursors D, distal ratio, Cobb angle of the upper fixed vertebra, JOA and ODI low back pain scores, and lumbar spine stiffness disability index score (P < 0.05), as shown in Table 3.

Table 3

Comparison of patients in short-segment group before operation and 6 months after operation

Preoperative Six months after operation t P
Apical rotation Nash Moe 1.60 ± 0.50 1.94 ± 0.77 1.481 0.148
Cobb angle (°) 8.80 ± 5.17 9.23 ± 4.34 0.254 0.800
Coronal imbalance value (mm) 55.30 ± 3.66 11.27 ± 6.12 24.700 <0.05
Lateral sliding of apical vertebra (mm) 6.54 ± 4.94 9.28 ± 3.70 0.829 0.413
Lumbar lordosis (°) 18.13 ± 12.40 31.15 ± 11.56 2.678 <0.05
Sagittal imbalance value (mm) 33.83 ± 17.90 15.24 ± 2.94 4.099 <0.05
Pelvic projection angle (°) 56.33 ± 9.70 25.43 ± 9.17 9.260 <0.05
Pelvic inclination angle (°) 44.37 ± 7.22 20.54 ± 1.26 13.010 <0.05
Sacral inclination angle (°) 42.66 ± 11.98 19.25 ± 6.90 6.773 <0.05
Proximal intervertebral space height A (mm) 10.62 ± 2.25 7.56 ± 3.16 3.155 <0.05
Proximal intervertebral space height B (mm) 7.28 ± 2.20 4.08 ± 2.26 4.058 <0.05
Posterior diameter of proximal vertebral precursor D (mm) 41.27 ± 5.29 28.99 ± 12.12 3.714 <0.05
Proximal ratio (A + B)/2/D 0.22 ± 0.06 0.44 ± 0.85 1.033 0.309
Distal intervertebral space height A (mm) 10.23 ± 2.84 9.69 ± 3.47 0.481 0.633
Distal intervertebral space height B (mm) 7.37 ± 2.29 8.51 ± 2.62 1.310 0.199
Posterior diameter of distal vertebral precursor D (mm) 42.76 ± 5.76 29.75 ± 10.69 4.286 <0.05
Distal ratio (A + B)/2/D 0.21 ± 0.04 0.35 ± 0.17 3.207 <0.05
Cobb angle of upper fixed vertebra (°) 4.95 ± 3.33 20.13 ± 9.44 4.338 <0.05
Cobb angle of lower fixed vertebra (°) 5.20 ± 2.90 18.21 ± 9.92 1.293 0.205
JOA low back pain score 6.31 ± 2.36 13.13 ± 2.83 13.110 <0.05
ODI score of low back pain 69.44 ± 8.94 35.70 ± 18.07 6.694 <0.05
Lumbar spine stiffness disability index score 2.50 ± 0.52 2.01 ± 0.41 2.960 <0.05

A comparison of treatment effects in patients in the short-segment group preoperatively and 1 year postoperatively revealed significant differences in apical rotation Nash Moe, coronal imbalance value, lateral sliding of the apical vertebra, sagittal imbalance value, PPA, PI angle, sacral inclination angle, proximal intervertebral space heights A and B, posterior diameter of the proximal and distal vertebral precursors D, proximal and distal ratios, distal intervertebral space heights A and B, Cobb angle of the upper and lower fixed vertebrae, JOA and ODI low back pain scores, and lumbar spine stiffness disability index score (P < 0.05), as shown in Table 4.

Table 4

Comparison of patients in short-segment group before operation and 1 year after operation

Preoperative One year after operation t P
Apical rotation Nash Moe 1.60 ± 0.50 1.12 ± 0.70 2.232 <0.05
Cobb angle (°) 8.8 ± 5.17 7.79 ± 3.26 0.661 0.513
Coronal imbalance value (mm) 55.30 ± 3.66 8.61 ± 7.80 21.680 <0.05
Lateral sliding of apical vertebra (mm) 6.54 ± 4.94 6.27 ± 1.84 3.255 <0.05
Lumbar lordosis (°) 18.13 ± 12.4 49.41 ± 10.89 1.675 0.104
Sagittal imbalance value (mm) 33.83 ± 17.9 11.47 ± 9.25 4.439 <0.05
Pelvic projection angle (°) 56.33 ± 9.7 15.54 ± 6.23 14.15 <0.05
Pelvic inclination angle (°) 44.37 ± 7.22 16.48 ± 6.32 11.63 <0.05
Sacral inclination angle (°) 42.66 ± 11.98 15.32 ± 4.54 8.536 <0.05
Proximal intervertebral space height A (mm) 10.62 ± 2.25 16.68 ± 5.85 3.867 <0.05
Proximal intervertebral space height B (mm) 7.28 ± 2.20 17.56 ± 7.64 5.172 <0.05
Posterior diameter of proximal vertebral precursor D (mm) 41.27 ± 5.29 25.19 ± 10.55 5.450 <0.05
Proximal ratio (A + B)/2/D 0.22 ± 0.06 0.81 ± 0.47 4.981 <0.05
Distal intervertebral space height A (mm) 10.23 ± 2.84 12.16 ± 3.39 1.746 <0.05
Distal intervertebral space height B (mm) 7.37 ± 2.29 12.41 ± 5.15 3.577 <0.05
Posterior diameter of distal vertebral precursor D (mm) 42.76 ± 5.76 29.54 ± 12.61 3.814 <0.05
Distal ratio (A + B)/2/D 0.21 ± 0.04 0.50 ± 0.27 4.250 <0.05
Cobb angle of upper fixed vertebra (°) 4.95 ± 3.33 16.75 ± 7.69 6.406 <0.05
Cobb angle of lower fixed vertebra (°) 5.20 ± 2.90 15.35 ± 6.38 3.539 <0.05
JOA low back pain score 6.31 ± 2.36 22.32 ± 2.21 3.575 <0.05
ODI score of low back pain 69.44 ± 8.94 32.5 ± 9.44 11.360 <0.05
Lumbar spine stiffness disability index score 2.5 ± 0.52 1.56 ± 0.51 5.162 <0.05

A comparison of treatment effects in patients in the short-segment group preoperatively and 2 years postoperatively revealed significant differences in apical rotation Nash Moe, Cobb angle, coronal imbalance value, lateral sliding of the apical vertebra, sagittal imbalance value, PPA, PI angle, sacral inclination angle, proximal intervertebral space heights A and B, posterior diameter of the proximal and distal vertebral precursors D, proximal and distal ratios, distal intervertebral space heights A and B, Cobb angle of the upper and lower fixed vertebrae, JOA and ODI low back pain scores, and lumbar spine stiffness disability index score (P < 0.05), as shown in Table 5.

Table 5

Comparison of patients in short-segment group before operation and 2 years after operation

Preoperative Two years after operation t P
Apical rotation Nash Moe 1.60 ± 0.50 0.75 ± 0.58 4.440 <0.05
Cobb angle (°) 8.80 ± 5.17 5.33 ± 3.40 2.243 <0.05
Coronal imbalance value (mm) 55.30 ± 3.66 4.32 ± 3.73 39.020 <0.05
Lateral sliding of apical vertebra (mm) 6.54 ± 4.94 5.06 ± 0.88 4.101 <0.05
Lumbar lordosis (°) 18.13 ± 12.40 40.28 ± 11.56 0.5238 0.604
Sagittal imbalance value (mm) 33.83 ± 17.90 10.23 ± 5.85 5.013 <0.05
Pelvic projection angle (°) 56.33 ± 9.7 18.52 ± 2.71 15.020 <0.05
Pelvic inclination angle (°) 44.37 ± 7.22 15.32 ± 8.39 10.500 <0.05
Sacral inclination angle (°) 42.66 ± 11.98 10.23 ± 4.34 10.180 <0.05
Proximal intervertebral space height A (mm) 10.62 ± 2.25 14.6 ± 7.97 1.922 0.064
Proximal intervertebral space height B (mm) 7.28 ± 2.20 17.84 ± 6.89 5.840 <0.05
Posterior diameter of proximal vertebral precursor D (mm) 41.27 ± 5.29 22.04 ± 10.91 6.344 <0.05
Proximal ratio (A + B)/2/D 0.22 ± 0.06 0.93 ± 0.57 4.955 <0.05
Distal intervertebral space height A (mm) 10.23 ± 2.84 12.51 ± 4.41 1.739 0.092
Distal intervertebral space height B (mm) 7.37 ± 2.29 12.70 ± 5.63 3.508 <0.05
Posterior diameter of distal vertebral precursor D (mm) 42.76 ± 5.76 30.74 ± 9.15 4.447 <0.05
Distal ratio (A + B)/2/D 0.21 ± 0.04 0.43 ± 0.14 6.044 <0.05
Cobb angle of upper fixed vertebra (°) 4.95 ± 3.33 15.26 ± 6.30 7.916 <0.05
Cobb angle of lower fixed vertebra (°) 5.20 ± 2.90 14.67 ± 5.21 4.615 <0.05
JOA low back pain score 6.31 ± 2.36 18.21 ± 2.42 8.283 <0.05
ODI score of low back pain 69.44 ± 8.94 7.65 ± 3.51 25.730 <0.05
Lumbar spine stiffness disability index score 2.50 ± 0.52 1.50 ± 0.52 5.439 <0.05

3.3 Factors associated with osteoarthritis

In the above study, we found that short-segment fixation was more effective in DS. To further explore the factors associated with ASD, we examined ASD in 10 out of 64 patients with short-segment fixation. These patients were divided into the ASD (n = 10) and NASD (n = 54) groups. In the ASD group, 10 patients (15.6%) had ASD on the cranial side. In the NASD group, 54 patients (84.4%) had no ASD on the caudal side. When comparing the ASD and NASD groups, the differences in demographic factors such as mean follow-up time, gender, age, smoking status, BMI, preoperative low back pain VAS score, preoperative leg pain VAS score, and preoperative ODI score were not statistically significant (P > 0.05), as shown in Table 6.

Table 6

Comparison of demographic parameters of patients in the ASD and N-ASD groups

Related factors ASD group (n = 10) NASD group (n = 54) P
Duration of follow-up visits (months) 27.5 ± 6.4 27.3 ± 11.8 0.985
Age (years) 66.8 ± 3.9 64.3 ± 7.6 0.467
Gender 0.146
  Male 2 20
  Female 8 34
Smoking 0.517
  Yes 3 7
  No 7 47
BMI 25.5 ± 3.4 24.1 ± 2.8 0.302
Pre-operative low back pain VAS 6.0 ± 0.5 5.3 ± 1.1 0.395
Pre-operative leg pain VAS 4.2 ± 1.4 3.9 ± 1.3 0.687
Pre-operative ODI (%) 53.7 ± 3.5 51.5 ± 4.6 0.321

Statistical analysis of surgically relevant variables showed no statistically significant differences between the two groups in the number of fused segments, operative segments, operative time, bleeding, and other surgical variables. No statistical analysis was carried out on adjacent synovial joints, as none occurred intraoperatively in either group (Table 7).

Table 7

Comparison of surgery-related factors between patients in the ASD and NASD groups

Related factors ASD group (n = 10) NASD group (n = 54) P
Number of fusions 0.063
  1 0 24
  2 8 21
  3 2 9
Fusion of segments 0.450
  L3–L4 0 4
  L4–L5 0 15
  L5–S1 0 3
  L2–L4 0 5
  L3–L5 6 8
  L4–S1 3 7
  L1–L4 0 2
  L2–L5 1 6
  L3–S1 0 4
Operating time (min) 218.1 ± 16.8 196.5 ± 52.1 0.334
Bleeding volume (mL) 829.6 ± 134.3 756.1 ± 374.8 0.639

When comparing imaging factors between the two groups, preoperative PT (33.4 ± 9.5 vs 20.8 ± 8.1; P = 0.003), preoperative PI (54.8 ± 8.0 vs 45.6 ± 6.7; P = 0.006), preoperative PI–LL (32.2 ± 15.6 vs 17.9 ± 12.2; P = 0.0018), and preoperative coronal Cobb angle (28.4 ± 4.1 vs 19.6 ± 6.5; P = 0.009) were higher in patients with adjacent vertebral involvement compared to those without (P < 0.05), as shown in Table 8.

Table 8

Comparison of imaging parameters between patients in the ASD and NASD groups

Related factors ASD group (n = 10) NASD group (n = 54) P
LL (°) 22.6 ± 17.0 29.4 ± 17.8 0.405
PI (°) 54.8 ± 8.0 45.6 ± 6.7 0.006*
PT (°) 33.4 ± 9.5 20.8 ± 8.1 0.003*
SS (°) 21.6 ± 10.5 24.7 ± 9.4 0.503
PI–LL (°) 32.2 ± 15.6 17.9 ± 12.2 0.018*
LASD (mm) 13.3 ± 17.4 14.8 ± 25.3 0.866
Cobb (°) 28.4 ± 4.1 19.6 ± 6.5 0.009*
Degeneration of adjacent intervertebral discs 0.524
≥Class III 0.524
  Yes 8 49
  No 2 5

Note: *P < 0.05 and **P < 0.01 compared to the ASD group; lordosis; SS, sacral tilt angle; PT, pelvic tilt angle; PI, pelvic projection angle; PI–LL, degree of matching of pelvic projection angle to lumbar lordosis; LASD, distance between L1 lead line and S1.

4 Discussion

ADS is primarily a spinal deformity seen in middle-aged and elderly patients without a history of scoliosis. Degenerative changes, such as those affecting the lumbar disc and facet joints, can lead to scoliosis. This condition mostly affects the thoracolumbar and lumbar segments, primarily due to asymmetric degeneration of the lumbar spine [13].

Asymmetric degeneration of the intervertebral disc and facet joint leads to an asymmetric load on the spine segment, resulting in asymmetric deformity. This, in turn, exacerbates the original asymmetric degeneration and load, creating a vicious cycle that ultimately leads to DS [14,15]. In this condition, low back pain and neurogenic claudication are the main symptoms. The pain, primarily low back and lower limb pain, is due to muscle spasticity caused by scoliosis deformity and radiating pain from nerve root compression [16]. Neurogenic pain is mainly caused by the compression of both convex and concave nerve roots due to intervertebral disc protrusion, lateral recess stenosis, and articular process hyperplasia in DS [17]. Patients with DS often present with low back pain, leg pain, and spinal imbalance. Lameness or root pain is caused by spinal stenosis or rotational subluxation, where nerve roots are compressed due to the blending of the concave pedicle or stretching of the convex pedicle. Correcting rotational subluxation can help decompress nerve roots and reduce leg pain [18]. Sagittal plane imbalance leads to muscle strength imbalance and low back pain [19]. Therefore, it is recommended to restore the sagittal plane imbalance. The primary goal of surgical treatment for DS is to relieve symptoms, including leg and back pain, with deformity correction as a secondary objective [20].

Surgical treatments for ADS include simple decompression, post-decompression long- and short-segment fusion, and fixation. To avoid spinal instability caused by laminectomy, internal fixation and fusion surgery are often combined with decompression to maintain spinal stability and overall balance after reconstruction [21,22]. Patients with ADS often have osteoporosis, which increases surgical complications and difficulty. Therefore, the choice between long-segment and short-segment fixation for fusion remains highly controversial as surgeons strive to ensure therapeutic effectiveness while minimizing injuries [23].

At the last follow-up, the ODI score for the short-segment group was 7.65 ± 3.51, while for the long-segment group, it was 16.13 ± 4.16, indicating a significant difference between the two groups. Although both groups showed improvement, the degree of improvement significantly differed between them. Short-segment and long-segment surgeries have distinct clinical advantages. Short-segment surgery entails less trauma and shorter recovery times, whereas long-segment surgery imposes greater trauma on the tissues surrounding the injured site, potentially impeding nerve and muscle recovery and prolonging healing time.

If there is no obvious imbalance in the coronal and sagittal planes of the patient, fixation may only be required within the lateral bending range. Short-segment fixation and fusion can be utilized to address the responsible decompression segment while stabilizing the spine, thereby preventing scoliosis progression and iatrogenic spine instability-induced decompensation. Considering the findings of this study, if there are multiple underlying medical conditions preoperatively and imaging indicates a minimal Cobb angle (<20°) or no significant imbalance between the coronal and sagittal spinal positions, responsible segmental decompression with short-segmental fusion and internal fixation can be considered to alleviate symptoms. Treatment in such cases may not necessarily entail excessive pursuit of deformity correction [21].

To achieve optimal surgical outcomes, restoring sagittal plane balance is crucially important. The restoration of lumbar physiological lordosis significantly impacts the efficacy of surgery. Additionally, the fatigue and spasms of paraspinal muscles resulting from coronal plane imbalance can induce axial pain in patients, and a Cobb angle ≥30° is also a risk factor for DS progression [22]. In line with the findings of this study, in cases of severe spinal deformity characterized by a Cobb angle >20°, accompanied by significant loss of LL and sacral inclination angle, as well as three-dimensional spinal deformity, long-segment internal fixation and fusion may be preferred. This approach aims to achieve superior deformity correction, maintain spine stability, and yield satisfactory surgical outcomes.

Overall, the approach to treating patients with DS depends on the severity of the condition. For those with a small coronal Cobb angle, short-segment decompressive-fusion internal fixation is typically recommended. Conversely, patients with large coronal Cobb angles and significant sagittal and coronal imbalances usually require long-segment decompressive fusion internal fixation. However, it is crucial to consider that DS commonly occurs alongside multiple medical comorbidities in older patients, which can increase the risk of perioperative complications. Therefore, extending the fusion length may further elevate these risks. Presently, posterior short-segment lumbar fixation and fusion represent a critical surgical approach for managing DS [7]. In a meta-analysis comparing short-segment fusion to long-segment fusion for balanced DS, Lee et al. [24] found comparable decreases in patient ODI scores after 2 years of follow-up for both procedures. Notably, the short-fusion group exhibited reduced bleeding and shorter operative time compared to the long-fusion group. Patients undergoing short-segment lumbar fixation and fusion in this study demonstrated varying degrees of improvement in VAS and ODI scores for low back pain at 3 months postoperatively and during the final follow-up compared to the preoperative measures. Despite the favorable clinical outcomes associated with posterior short-segment lumbar fixation and fusion, it is important to acknowledge the potential complications, including implant failure, pseudoarthrosis, sagittal spine imbalance, and ASD. Additionally, the procedure alters the normal biomechanics of the spine by rigidly fusing segments, thereby increasing mechanical stress on adjacent segments and accelerating the degeneration of adjacent discs. Consequently, the development of ASD postoperatively significantly influences the need for reoperation after spinal fusion.

This retrospective study aimed to assess the incidence of ASD and its possible correlates in patients with DS who underwent lumbar fixed fusion. A total of 96 patients were included in the analysis, among whom 15 (15.6%) developed ASD. Notably, imaging degeneration of the adjacent segmental disc was frequently observed, although it did not always manifest with accompanying clinical symptoms. Park et al. reported that over a minimum follow-up period of 5 years, 42.6% of patients exhibited imaging evidence of ASD, with 30.3% experiencing symptomatic ASD [25]. Prior investigations have documented varying rates of ASD following lumbar fusion, ranging from 5 to 27%. In this study, ASD was defined as symptomatic ASD, with the study population exclusively comprising adult patients with DS. The observed incidence of symptomatic ASD in our study, at 15.6%, aligns closely with previously reported rates.

Debate persists regarding the influence of pre-existing disc degeneration on the onset of ASD. Studies have suggested a correlation between preoperative disc degeneration and the subsequent development of symptomatic ASD postoperatively. Clinical case studies and biomechanical analyses have consistently shown that postoperative ASD tends to be more prevalent in patients with advanced preoperative disc degeneration [26–28]. However, a minority of authors have suggested that postoperative symptomatic ASD may not be associated with pre-existing disc degeneration [29]. In our study, we found no association between pre-existing disc degeneration and the occurrence of postoperative symptomatic ASD. This outcome might be attributed to the presence of DS in our study cohort. The prevalence of preoperative disc degeneration in the adjacent segments did not significantly differ between the two groups in this study. Fixed fusion procedures lead to diminished elasticity and increased stiffness in the lumbar segment, resulting in biomechanical alterations in adjacent motion segments. These changes include stress concentration, increased segmental mobility, and elevated intradiscal pressure.

Following lumbar fusion surgery, biomechanical changes can induce progressive degeneration in healthy, mobile segments adjacent to the fusion site. Additionally, discs that have already degenerated in adjacent fused segments are predisposed to further degeneration postoperatively due to inherent functional decline and biomechanical changes. This progression can result in symptomatic ASD [30]. Consequently, the selection of the superior fusion segment becomes contentious, particularly in cases where there is significant disc degeneration in the adjacent segment compared to the targeted fused segment. Surgeons should consider preoperative disc degeneration in the adjacent fused segment when devising the surgical fusion plan to optimize patient outcomes.

In recent years, the impact of sagittal imbalance on the occurrence of ASD has garnered significant scholarly interest. Studies have consistently demonstrated an association between poor sagittal alignment and the development of ASD. Senteler et al. [31] reported that individuals with a high PI and reduced LL were predisposed to ASD, with those exhibiting a PI–LL mismatch (≥10°) having a tenfold higher risk of ASD compared to those without such a mismatch. Nakashima et al. similarly concluded that a high PI was significantly associated with the development of ASD. Phan et al. [32] found that preoperative PT and PI–LL were larger, while SS and LL were smaller in patients with postoperative ASD compared to controls, indicating significant correlations between changes in sagittal parameters (PT, SS, PI–LL, and LL) and the development of ASD. Moreover, Saitoh et al. found that preoperative LL was significantly lower and PT was significantly higher in the postoperative ASD group compared to controls. Additionally, they noted that 75% of patients with ASD exhibited a PI–LL mismatch (≥10°), highlighting high preoperative PT, low LL, and a PI–LL mismatch as significant risk factors for the development of postoperative ASD [33].

In this study, we observed no statistical difference in preoperative SS and LL values between the ASD and NASD groups. However, significant differences were noted in preoperative PI and PT between the ASD and NASD groups. Additionally, the preoperative PI–LL values exhibited a significant difference between the two groups, with patients in the ASD group demonstrating significantly higher preoperative PI, PT, and PI–LL values compared to the NASD group. These findings suggest a potential association between elevated preoperative PI, PT, and PI–LL values and the onset of ASD. Our study results are consistent with those reported by Phan and Matsumoto et al., underscoring the importance of further investigations with larger sample sizes to elucidate the relationship between spinal-pelvic imaging parameters and ASD. Bagheri et al. concluded that the distance between the L1 lead line and the posterior superior angle of S1 (LASD) was predictive of the development of ASD after lumbar fusion [34]. Lee and Park showed that preoperatively, patients with negative LASD were 5.6 times more likely to develop ASD postoperatively than those with positive LASD. However, LASD values did not exhibit statistical significance between the ASD and NASD groups in our analysis [12]. Few studies have explored the correlation between preoperative coronal Cobb angle and the occurrence of ASD following short-segment decompression fusion internal fixation, commonly employed in patients with minor Cobb angles or mild lateral displacement. Kim et al. found that long-segment internal fusion was more effective in correcting scoliosis angles and coronal imbalances, particularly in patients with Cobb angles >25° [35]. In our study, patients in the ASD group exhibited a significantly larger preoperative coronal Cobb angle compared to the NASD group, suggesting that a substantial preoperative coronal Cobb angle may contribute to the development of ASD following short-segment decompression fusion internal fixation in patients with DS.

Our study has several limitations. First, it was retrospective in nature, precluding the collection of prospective data and potentially introducing selective bias due to the loss of imaging data. Second, the sample size was insufficient to facilitate accurate regression analysis of the variables of interest and their relationship to ASD. Therefore, expanding the sample size is essential for further studies to delve deeper into this association. Third, the mean follow-up period in our study was relatively short, providing only interim efficacy data. Future investigations with longer follow-up periods are necessary to establish definitive conclusions regarding the incidence of ASD and its associated factors. Lastly, the findings of our study are of limited scope and applicability, necessitating further expansion and exploration.

When developing and optimizing a surgical strategy for DS, it is crucial to consider the clinical symptoms, general condition, and imaging presentation of the patient. While short-segment fixation and fusion have demonstrated considerable success in improving dysfunction and relieving pain, it is important to note that patients undergoing these procedures are typically elderly and susceptible to persistent back pain and accelerated degeneration of adjacent segments. Therefore, this study represents a significant contribution toward mitigating back pain and lowering the risk of adjacent segment degeneration in the elderly population.

  1. Funding information: This research was supported by the Ningxia Natural Science Foundation Project NZ16126, Ningxia Natural Science Foundation Project 2020AAC03390, and Ningxia Medical University Research Project XT2020008.

  2. Author contributions: Long Pang designed the study; Long Pang carried out the experiments and wrote the manuscript; Long Pang revised the article; Zhihui Gao, Long Ma, Yaping Li, Zhidong Lu, Liang Zhang, Peng Li, and Long Wu collected patient specimens and related information; Zhihui Gao, Long Ma, Yaping Li, Zhidong Lu, Liang Zhang, Peng Li, and Long Wu contributed to analyzing the data. All authors reviewed the results and approved the final version of the manuscript.

  3. Conflict of interest: The authors declare that they have no conflict of interest.

  4. Data availability statement: The data used to support the findings of this study are available from the corresponding author upon request.

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Received: 2023-12-24
Revised: 2024-05-22
Accepted: 2024-05-22
Published Online: 2024-06-21

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
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  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
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  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
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  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
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  96. Population pharmacokinetics of meropenem in critically ill patients
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  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
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  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
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  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
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  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
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  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
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https://doi.org/10.1515/med-2024-0983
Keywords for this article
long-segment internal fixation; short-segment internal fixation; degenerative scoliosis; adjacent vertebral disease; coronal Cobb’s angle
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
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