Functional outcome of non-surgical and surgical management for de novo degenerative lumbar scoliosis: a mean follow-up of 10 years

Abstract

BackgroundNo studies have evaluated the long-term results of non-surgical and surgical management in de novo degenerative lumbar scoliosis (DNDLS). This study reports on the long-term functional outcome of patients being treated for DNDLS by non-surgical and surgical management.MethodsThis is a retrospective review of a single center database of DNDLS patients that underwent surgical or usual non-surgical management between 1996 and 2007. In a total of 88 patients, 50 (57%) underwent non-surgical and 38 (43%) surgical management. Baseline demographic, radiological-, clinical-, and surgical-related variables were collected. An Oswestry Disability Index (ODI) 2.0 questionnaire was sent to all patients after written informed consent.ResultsTwenty-nine of 88 patients participated in the study, 15 (52%) had undergone surgical and 14 (48%) non-surgical management with a mean follow-up of 10.9 years (range 8–15 years). There were no significant differences (p > 0.05) between non-surgical and surgical patients at baseline for age, body mass index, coronal Cobb angle, and clinical data. None of the non-surgical patients had undergone surgery during follow-up. In the surgical group, 40% had revision surgery. There was no significant difference in ODI total scores between groups at final follow-up (p = 0.649). A larger proportion of patients in the non-surgical group reported an ODI total score of ≤ 22, reflecting minimal disability (43 versus 20%; p = 0.245).ConclusionsThis is the first study that describes the long-term 10-year functional outcome of non-surgical and surgical management in a cohort of patients with DNDLS. No significant difference in functional outcome was found between groups after a mean follow-up of 10 years. Despite the significant potential for selection bias, these results indicate that non-surgical management of patients with DNDLS may lead to adequate functional outcome after long periods of time, with no crossover to surgery. Further study is warranted to define which patients may benefit most from which management regimen.

The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study

“…45 Patients with degenerative lumbar scoliosis present at a relatively high age, often with several comorbidities and poor bone quality. 1,25,45,52 This increases the risk of intra-and postoperative complications, 15,21 which is shown by a study of Transfeldt et al, who reported a complication rate of 40%-56% after spinal fusion, compared to only 10% in decompression alone. 47 FIG.…”

Unfulfilled Expectations After Surgery for Adult Lumbar Scoliosis Compared with Other Degenerative Conditions

“…From February 2010 to August 2012, 420 consecutive patients were enrolled in the study; from April 2012 to September 2014, 366 of these had follow-up telephone calls. Of those with follow-ups, 42 had a primary diagnosis of scoliosis (mainly de novo adult degenerative subtype), and 134 were within the desired age range and had other primary degenerative conditions (disc disease 24, stenosis 66, spondylolisthesis 44) and comprised the comparison (control) group [1, 8]. Pain relief was the main reason for surgery in both groups.…”

Decision Making for Surgery in Adult Scoliosis Review of the Current Literature

“…Although more likely to experience complications, the older and more disabled patients may actually stand to gain the most from surgical intervention 2017 Teles et al (63) Review -No randomized controlled trial was identified in our search to support the long-term value of current nonsurgical therapeutic options 2017 Faraj et al (18) R >10°-55°No significant difference in functional outcome was found between surgical and nonsurgical groups after a mean follow-up of 10 years. Certain patients can benefit from nonsurgical management after long periods of time…”