Lumbar degenerative scoliosis: outcomes of combined anterior and posterior pelvis surgery with minimum 2-year follow-up

Abstract

Combined anterior and posterior surgery is useful for fixed deformity of the lumbar spine. The specific indications for and clinical outcome parameters after combined surgery for patients with degenerative lumbar scoliosis have not been well defined. We retrospectively reviewed 14 consecutive patients with degenerative lumbar scoliosis treated with combined anterior and posterior arthrodesis with instrumentation to the pelvis. Mean patient age was 65 years (range, 49-88 years) and mean clinical follow-up was 44 months (range, 30-78 months). Mean preoperative sagittal imbalance was 4.6 cm (range, 1.5-15.5 cm), which was maintained to 2.5 cm (range, 0.5-8 cm) at last follow-up. Mean preoperative Cobb angle of the major curve was 46 degrees (range, 20 degrees-67 degrees), which improved to 6 degrees (range, 2 degrees-30 degrees) at last follow-up. The highest total postoperative scores were reported in patients with maximal correction of their curves at last follow-up. Correlation analysis of clinical outcome domains demonstrated that patient satisfaction with surgical management correlated strongly with domains of pain (r=0.86; P=.008) and weakly with domains of function (r=0.3; P=.02). Patients with degenerative lumbar scoliosis may be effectively treated with combined anterior and posterior surgery with instrumentation to the pelvis. Our results at a minimum of 2-year follow-up indicate that overall clinical outcomes are best in cases with maximal curve correction, and overall patient satisfaction with surgery is correlated with relief from pain.