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

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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.

 

 

Group 1 (N=9)

Group 2 (N=22)

Group 3 (N=5)

Coronal Cobb (º)

 

Preop average

17.1

18.1

22.8

 

Range

7 to 23

10 to 28

12 to 30

 

Postop average

21.4

16

17.4

 

Range

14 to 32

0 to 30

7 to 35

Coronal Subluxation (mm)

 

Preop average

7.1

9.2

11.8

 

Range

4 to 13

3 to 15

8 to 17

 

Postop average

7.1

5.5

4.7

 

Range

3 to 14

1 to 8

0 to 8

LIV Tilt (º)

 

Preop average

5.6

7.1

15

 

Range

2 to 8

0 to 27

7 to 25

 

Postop average

8.1

5.9

7.4

 

Range

3 to 12

0 to 20

3 to 11

T12-SAC Cobb (º)

 

Preop average

-49.2

–42

–44.6

 

Range

–72 to –18

–63 to –19

–50 to –39

 

Postop average

-48.1

–38.5

–40

 

Range

–68 to –14

–66 to –12

–46 to –35

Decompression Levels Cobb (º)

 

Preop average

-29.1

–17.2

–25.4

 

Range

–57 to –15

–40 to +13

–38 to –4

 

Postop average

–26.6

–19.2

–24.8

 

Range

–41 to –12

–45 to 0

–37 to –4

Oswestry Disability Index

Preop average

34.7

39.2

58

 

Range

20 to 40

14 to 69

40 to 70

 

Postop average

21

32.4

30

 

Range

0 to 32

0 to 78

22 to 36

 

Change

13.7*

6.8*

28*

Age (yrs)

Average

71.2

69.7

69.8

Range

61 to 81

53 to 82

60 to 81

Blood Loss (cc)

Average

250*

586.4

540

Range

100 to 500

250 to 2000

400 to 700

Length of surgery

Average min.

143.4*

232.1

283.6

 

Range

107 to 285

139 to 373

139 to 306

Length of Hospital stay

Average Days

4.8

5.9

6

 

Range

2 to 7

3 to 13

5 to 7