Comparison of 3 surgical treatments for degenerative lumbar scoliosis with symptomatic spinal stenosis

2009

SUMMARY

Degenerative lumbar scoliosis (DLS) with spinal stenosis (SS) is a very common problem for which older patients are seeking treatment when it interferes with their lifestyle. Our study shows that in properly selected patients, surgery for DLS with SS does provide successful clinical and radiographic outcomes and can benefit the aging population.

INTRODUCTION

The purpose of our study was to compare 3 different surgical treatments of increasing magnitude for previously untreated degenerative lumbar scoliosis (DLS) with spinal stenosis (SS) with respect to radiographic and clinical outcomes.

METHODS

A detailed analysis of 36 DLS patients surgically treated from 1994-2004 was performed. Inclusion criteria: age >50, lumbar scoliosis 10-30°, operative SS, =1 level of rotatory subluxation, 1-3 level decompression, lumbar fusion only, and minimum 2-year radiographic and clinical follow-up. Patients were divided into 3 groups: 1. decompression alone (n=9; 4M/5F; avg age 71.2); 2. decompression/short fusion (1-2 level) (n=22; 11M/11F; avg age 69.7); and 3. decompression/long fusion (=3 levels) (n=5; 2M/3F; avg age 69.8).

RESULTS

(see table) Average levels decompressed for groups 1, 2 and 3 were 2.1, 1.9 and 3 respectively. Average fusion levels for group 2 were 1.6 and 3 for group 3. Mean coronal Cobb angles were 17.1º, 18.1º and 22.8º preop and 21.4º, 16.0º and 17.4º postop; mean sagittal T12-S1 angles were –49.2º, –42º and –44.6º preop and –48.1º, –38.5º and –40º postop for groups 1, 2 and 3 respectively. There were no significant overall or intragroup pre/postop radiographic changes (p>0.05). As expected, blood loss and OR time was statistically lower in group 1 vs groups 2 and 3 (p<0.05). Average ODI scores for Groups 1, 2, and 3 were 34.7, 39.2 and 58 preop and 21, 32.4 and 30 postop. There was significant improvement in each pre/postop group and in overall ODI scores (preop 42/postop 30, p=0.002) at final follow-up. Complications: Group 1: 1 wound drainage without infection, 1 patient with recurrent SS. Group 2: 1 wound infection requiring I & D, 1 DVT, 2 with recurrent SS. Group 3: No complications.

CONCLUSION

Patients with DLS (10-30º) and SS can be managed by 1 of 3 treatments presented. As evidenced by the improvement in ODI scores and minimal complications, our study found each of the treatments is a viable option to provide successful clinical and radiographic outcomes for DLS with SS.