The prevalence of disc aging and back pain after fusion extending into thelower lumbar spine - A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis

Purpose: To determine the long-term outcome after fusion for adolescent idi opathic scoliosis in terms of degenerative disc findings diagnosed using MR imaging and to elucidate the clinical consequences. Material and Methods: Thirty-two patients with adolescent idiopathic scolio sis, who had undergone spinal fusion using Harrington rods to the lower lum bar spine with one or two unfused discs below the fusion, were re-examined 25 years after the fusion. The re-examinations included validated questionn aires, clinical examination, full standing frontal and lateral radiographs and MR examination of the lower lumbar region. Curve size and degenerative findings on MR images were evaluated by two unbiased radiologists, blinded to the clinical findings. A matched control group of 32 persons without sco liosis was subjected to the same examinations. Results and Conclusion: There were significantly more degenerative disc cha nges (p<0.0001), disc height reduction (p=0.0010) and end-plate changes (p< 0.0001 for both upper and lower end-plates) in the lowest unfused disc in t he patient group compared with the control group. The MR findings in the lo west unfused disc, but not the one above, in the patient group correlated t o lumbar pain intensity as well as to the diminished lumbar lordosis.