Abstract
Study Design
Longitudinal cohort.
Objective
To determine the outcomes of operative treatment of adult lumbar degenerative scoliosis (ALDS) with Cobb angles of 40° or less.
Summary of Background Data
Some ALDS patients have curves less than 40°. Although these curves may not need correction, the curve may alter the treatment paradigm for associated back and leg pain, requiring fusion to achieve adequate decompression and prevent deformity progression.
Methods
We reviewed hospital records and radiographs of 105 ALDS patients with curves from 10° to 40° who had decompression and instrumented fusion. We collected Oswestry Disability Index (ODI), Short Form—36 Physical (SF36 PCS), Mental Composite Scores (MCS), and back and leg pain scores preoperatively and 2 years postoperatively.
Results
The 105 patients had a mean age of 64.0 years and body mass index of 28.8 kg/m. There were 26 smokers (23%). Preoperative symptoms included both back and leg pain in 94% (mean back pain = 7.8; mean leg pain = 7.0). Mean preoperative Cobb was 22.7° and mean lumbar lordosis was 39.8°. The most common curve apex was L2 (43%) and L3 (39%). An average of 3.0 ± 1.6 levels were decompressed and fused. Mean postoperative Cobb was 17.6° and mean lumbar lordosis was 36.5°. The ODI improved 14.9 points (48.5 vs. 33.6; p <.0001), SF36 PCS improved 6.2 points (27.9 vs. 34.1; p <.0001), and SF36 MCS improved 4.7 points (40.5 vs. 45.1; p <.0001). Back (7.8 vs. 4.1; p <.0001) and leg pain (7.0 vs. 3.1; p <.0001) also improved at 2-year follow-up compared with baseline.
Conclusions
Many ALDS patients present with problems associated with lumbar degenerative disease rather than severe deformity, and may require decompression for leg pain or neurogenic claudication. Even in patients with limited back pain, fusion is often needed, because decompression alone may result in either inadequate decompression or progression of the deformity. Results of this study indicate that ALDS patients with curves less than 40° benefit from decompression and fusion.
Similar content being viewed by others
References
Bridwell KH, Glassman S, Horton W, et al. Does treatment (nonop-erative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis? A prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976) 2009;34: 2171-8.
Oskouian Jr RJ, Shaffrey CI. Degenerative lumbar scoliosis. Neuro-surg Clin North Am 2006;17:299–315.vii.
Schwab F, Lafage V, Farcy JP, et al. Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis: application of the new adult deformity classification. Spine (Phila Pa 1976) 2007;32:2723–30.
Milliman CareGuidlines, Inpatient and Surgical Care, 17th edition. Available at http://www.milliman.com/expertise/healthcare/products-tools/milliman-care-guidelines/index.php?gclid=COb30OLWm7ACFQcEnQodA048Xw. Accessed June 11, 2012.
Transfeldt EE, Topp R, Mehbod AA, Winter RB. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine (Phila Pa 1976) 2010;35:1872–5.
McCaffery M, Beebe A. Pain: Clinical Manual for Nursing Practice. Baltimore, MD: VV Mosby; 1993.
Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473–83.
Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271–3.
Roland M, Fairbank J. Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine (Phila Pa 1976) 2000;25:3115–24.
Copay AG, Glassman SD, Subach BR, et al. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 2008;8:968–74.
Hagg O, Fritzell P, Nordwall A. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 2003;12:12–20.
Shapiro GS, Taira G, Boachie-Adjei O. Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes. Spine (Phil Pa 1976) 2003;28:358–63.
Takahashi S, Delecrin J, Passuti N. Surgical treatment of idiopathic scoliosis in adults: an age-related analysis of outcome. Spine (Phila Pa 1976) 2002;27:1742–8.
Weidenbaum M. Considerations for focused surgical intervention in the presence of adult spinal deformity. Spine (Phila Pa 1976) 2006;31(19 Suppl):S139–43.
Carreon LY, Puno RM, Dimar II JR, et al. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 2003;85:2089–92.
Gupta MC. Degenerative scoliosis: options for surgical management. Orthop Clin North Am 2003;34:269–79.
Benner B, Ehni G. lumbar scoliosis. Spine (Phila Pa 1976) 1979;4:548–52.
Epstein JA, Epstein BS, Jones MD. Symptomatic lumbar scoliosis with degenerative changes in the elderly. Spine (Phila Pa 1976) 1979;4:542–7.
Tsai TH, Huang TY, Lieu AS, et al. Functional outcome analysis: instrumented posterior lumbar interbody fusion for degenerative lumbar scoliosis. Acta Neurochirurg 2011;153:547–55.
Cho KJ, Suk SI, Park SR, et al. Short fusion versus long fusion for degenerative lumbar scoliosis. Eur Spine J 2008;17:650–6.
Author information
Authors and Affiliations
Corresponding author
Additional information
Author disclosures: JJP (none); LYC (employment with Norton Healthcare; grants from Norton Healthcare; travel/accommodations/meeting expenses from National Institutes of Health, University of Louisville IRB, Department of Defense, Association for Collaborative Spine Research; honoraria for review panel participation from the Nations Institutes of Health); SDG (former board member for Medtronic Corporate Advisory Board; former consultant for Medtronic; employment with Norton Healthcare; grants from Norton Healthcare; patents from Medtronic; royalties from Medtronic; travel/accommodations/meeting expenses from Orthopedic Research and Education Fund).
Rights and permissions
About this article
Cite this article
Park, J.J., Carreon, L.Y. & Glassman, S.D. Adult Lumbar Degenerative Scoliosis 40° or Less: Outcomes of Surgical Treatment With Minimum 2-Year Follow-up. Spine Deform 1, 211–216 (2013). https://doi.org/10.1016/j.jspd.2013.03.003
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1016/j.jspd.2013.03.003