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

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Degenerative scoliosis is a common and important cause of lumbar spine deformity in the adult. The operative management of degenerative scoliosis encompasses a spectrum of approaches, including decompression alone, or fusion that may include posterior or anterior approaches. There exists significant variability in surgical approaches to degenerative scoliosis, and evidence to support a specific approach is limited. Including the structural thoracic spine in fusions to the thoracolumbar junction has a lower rate of revision than fusions with a cephalad segment at T12 or L1. Short fusions to L5 have a low rate of revision at a minimum follow-up of 2 years. Combined anterior and posterior surgery is more effective in improving lordosis than posterior-only surgery without osteotomies. Clinical outcomes of surgery for degenerative scoliosis are variable, andwct 2 self-reported scores for pain improve more reliably than scores for function. Further investigation, including comparison of randomized or matched cohorts and measurement of outcomes related to specific preoperative complaints, will be useful in the development of an evidence-based approach to degenerative scoliosis.

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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)

  • J.P. Kostuik

    Adult scoliosis

  • S.A. Grubb et al.

    Degenerative adult onset scoliosis

    Spine

    (1988)
  • W. Dick et al.

    Degenerative lumbar scoliosis and spinal stenosis

    Orthopade

    (1993)
  • C.B. Tribus

    Degenerative lumbar scoliosis: evaluation and management

    J Am Acad Orthop Surg

    (2003)
  • J.H. Healey et al.

    Structural scoliosis in osteoporotic women

    Clin Orthop Relat Res

    (1985 May)
  • G.C. Robin et al.

    Scoliosis in the elderly: a follow-up study

    Spine

    (1982)
  • F. Schwab et al.

    Adult scoliosis; a health assessment analysis by SF-36

    Spine

    (2003)
  • S. Berven et al.

    Studies in the modified Scoliosis Research Society outcomes instrument in adults: validation, reliability, and discriminatory capacity

    Spine

    (2003)
  • M. Aebi

    The adult scoliosis

    Eur Spine J

    (2005)
  • J.F. Fraser et al.

    Pathogenesis, presentation, and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities

    Neurosurg Focus

    (2003)
  • E.D. Simmons et al.

    The results of surgical treatment for adult scoliosis

    Spine

    (1993)
  • D. Bradford

    Adult scoliosis: current concepts of treatment

    Clin Orthop

    (1988)
  • E.D. Simmons

    Surgical treatment of patients with lumbar spinal stenosis associated with scoliosis

    Clin Orthop

    (2001)
  • S.D. Glassman et al.

    The selection of operative versus nonoperative treatment in patients with adult scoliosis

    Spine

    (2007)
  • J.A. Epstein et al.

    Symptomatic lumbar scoliosis with degenerative changes in the elderly

    Spine

    (1979)
  • A. Ploumis et al.

    Degenerative lumbar scoliosis: radiographic correlation of lateral rotatory olisthesis with neural canal dimensions

    Spine

    (2006)
  • B.A. Akbarnia et al.

    Debate: degenerative scoliosis

    Spine

    (2005)
  • J. Slover et al.

    The impact of comorbidities on the change in Short-Form 36 and Oswestry scores following lumbar spine surgery

    Spine

    (2006)
  • S.D. Glassman et al.

    Correlation of radiographic parameters and clinical symptoms in adult scoliosis

    Spine

    (2005)
  • F. Schwab et al.

    A lumbar classification of scoliosis in the adult patient: preliminary approach

    Spine

    (2005)
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