Operative Management of Degenerative Scoliosis: An Evidence-Based Approach to Surgical Strategies Based on Clinical and Radiographic Outcomes
Section snippets
Material and methods
A consecutive series of patients treated by means of surgery for a primary diagnosis of degenerative scoliosis at the University of California in San Francisco Medical Center was reviewed. The inclusion criteria for the diagnosis of degenerative scoliosis in this study included adults older than the age of 35 years with a lumbar major curve measuring greater than 15° without a structural thoracic curve and no known history of scoliosis as an adolescent. Patients with prior decompressive
Results
Sixty consecutive patients met the inclusion criteria of primary arthrodesis for degenerative scoliosis with cephalad fixation below T9. Complete data, including clinical and radiographic variables, were available for 38 patients (28 female and 10 male) with a minimum of 2 years of clinical follow-up. The average age of patients was 64 years (range: 40–82 years). Thirty patients were treated with a posterior-only fusion, 4 patients with anterior-only surgery, and 4 patients with a combined
Discussion
The surgical management of adult scoliosis is challenging, and results are variable. Age and surgical approach are important independent determinants of postoperative pain, with younger patients treated with anterior surgery reporting less postoperative pain than older patients treated with posterior surgery. Age is also an important independent predictor of postoperative function. The role of comorbidities is well established as an important determinant of postoperative health-related quality
References (61)
- et al.
Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis
Spine J
(2003) - et al.
Degenerative lumbar scoliosis
Neurosurg Clin N Am
(2006) Degenerative scoliosis. Options for surgical management
Orthop Clin North Am
(2003)- et al.
Lumbar spinal stenosis. Treatment strategies and indications for surgery
Orthop Clin North Am
(2003) Surgical management of complicated spinal stenosis associated with degenerative scoliosis
Operative Techniques in Orthopaedics
(1997)- et al.
Degenerative lumbar scoliosis
Spine
(1979) - et al.
Degenerative symptomatic lumbar scoliosis
Spine
(1993) - et al.
Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar scoliosis
Spine
(2002) - et al.
A prospective study of de novo scoliosis in a community-based cohort
Spine
(2006) Natural history of the aging spine
Eur Spine J
(2003)