Operative Management of Degenerative Scoliosis: An Evidence-Based Approach to Surgical Strategies Based on Clinical and Radiographic Outcomes

Berven, Sigurd; Deviren, Vedat; Mitchell, Brian; Wahba, George; Hu, Serena S.; Bradford, David S.

doi:10.1016/j.nec.2007.03.003

Cited by 59 publications

(22 citation statements)

References 53 publications

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“…Positive sagittal balance of more than 4 cm or flat back syndrome is an important factor in the final outcome [5,25]. Surgical options include decompression alone and decompression with fusion [5][6][7][8][9][28][29][30][31][32][33][34][35].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Degenerative Scoliosis: A Review

et al. 2011

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Degenerative lumbar scoliosis is a coronal deviation of the spine that is prevalent in the elderly population. Although the etiology is unclear, it is associated with progressive and asymmetric degeneration of the disc, facet joints, and other structural spinal elements typically leading to neural element compression. Clinical presentation varies and is frequently associated with axial back pain and neurogenic claudication. Indications for treatment include pain, neurogenic symptoms, and progressive cosmetic deformity. Non-operative treatment includes physical conditioning and exercise, pharmacological agents for pain control, and use of orthotics and invasive modalities like epidural and facet injections. Operative treatment should be contemplated after multi-factorial and multidisciplinary evaluation of the risks and the benefits. Options include decompression, instrumented stabilization with posterior or anterior fusion, correction of deformity, or a combination of these that are tailored to each patient. Incidence of perioperative complications is substantial and must be considered when deciding appropriate operative treatment. The primary goal of surgical treatment is to provide pain relief and to improve the quality of life with minimum risk of complications.

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Section: Surgical Treatmentmentioning

confidence: 99%

Degenerative Scoliosis: A Review

et al. 2011

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“…2 Pain is probably the most frequent indication for surgical treatment of spinal stenosis with DLS. Surgery is effective in decreasing the frequency and/or severity of the pain.…”

Section: Discussionmentioning

confidence: 99%

Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbar scoliosis

Lee

Jahng

Kim

2014

SPI

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Object Spinal stenosis with degenerative lumbar scoliosis (DLS) mostly occurs in the elderly population (typically > 65 years old), causing pain in the legs and back, claudication, and spinal deformity. The surgical strategy for DLS is controversial concerning the surgical approach, fusion area, decompression area, correction methods, and ideal angle of curve correction. A nonfusion stabilization system with motion preservation has been recently used for degenerative spinal diseases with favorable outcomes. This study attempted to analyze surgical outcomes after decompression and nonfusion stabilization for spinal stenosis with a mild to moderate degree of DLS. Methods Twenty-eight patients (21 women and 7 men, with a mean age of 65.3 years) with spinal stenosis and DLS who underwent decompressive surgery and nonfusion stabilization with the Dynesys system were included in this study. Medical records and radiological studies were reviewed to access clinical and radiological outcomes and surgery-related complications. Results Fifty-nine segments were decompressed and stabilized without fusion in 28 patients, consisting of 1 segmental stabilization in 8 patients (28.6%, L4–5), 2 segmental stabilizations in 11 patients (39.3%, L3–5), 3 segmental stabilizations in 7 patients (25.0%, L2–5 in 6 patients, L3–S1 in 1 patient), and 4 segmental stabilizations in 2 patients (7.1%, L2–S1 in 1 patient, L1–5 in 1 patient). The mean follow-up period was 30.7 months. Radiologically, the mean lumbar scoliotic angle was 13.7° before surgery, 5.1° at 3 months postoperatively, 3.8° at 12 months postoperatively, 4.2° at 24 months postoperatively, and 3.9° at the last follow-up, which was statistically significant (p < 0.05). Lumbar lordosis and range of motion were preserved. The score on the visual analog scale for leg and back pain significantly decreased, and the Oswestry Disability Index significantly improved after surgery. There were no newly developed neurological deficits or aggravation of neurological symptoms. A radiolucent line around the pedicle screw was observed in 4 patients (14.2%) with 5 screws (2.8%). Conclusions Adding nonfusion stabilization after decompressive surgery resulted in a safe and effective procedure for elderly patients with lumbar stenosis with a mild to moderate scoliosis angle (< 30°). Statistically significant improvement of the clinical outcome was obtained at the last follow-up evaluation with no progression of the degenerative scoliosis.

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“…3,4,8,17,[20][21][22]25 In the lumbar spine, scoliotic deformities will often be associated with a degree of VB angulation as well as a rotational deformity. Furthermore, unlike thoracic spinal deformity in which cosmetic concerns are prevalent, in lumbar degenerative scoliotic deformity the presenting complaint leading to treatment is most often a combination of axial and radicular pain.…”

Section: Discussionmentioning

confidence: 99%

“…23 The surgical goals in the treatment of lumbar scoliosis are neural decompression, reduction of the coronal plane deformity, maintenance of sagittal balance, and mechanical stabilization of the spine. 2,3,8,12,16,24,25 In this report, we describe a modification of our usual surgical technique of posterior lumbar interbody fusion, 9 which has been found useful for treating patients with lumbar scoliosis resulting in ipsilateral, symptomatic, nerve root compression.…”

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confidence: 99%

Correction of lumbar coronal plane deformity using unilateral cage placement

Heary¹,

Karimi²

2010

FOC

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The authors describe a surgical technique for the correction of symptomatic degenerative lumbar scoliosis. Using a single, unilateral, interbody cage placed on the concave side of the coronal deformity, combined with a dorsal decompression and instrumented posterolateral fusion, this technique has resulted in excellent curve correction, fusion results, and clinical outcomes in a series of 4 patients. Each of these patients presented with intractable, axial low-back pain and symptomatic unilateral nerve root compression on the concave side of a lumbar scoliotic deformity. The management is described in detail.

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Operative Management of Degenerative Scoliosis: An Evidence-Based Approach to Surgical Strategies Based on Clinical and Radiographic Outcomes

Cited by 59 publications

References 53 publications

Degenerative Scoliosis: A Review

Degenerative Scoliosis: A Review

Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbar scoliosis

Correction of lumbar coronal plane deformity using unilateral cage placement

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