Evaluation and Surgical Management of Adult Degenerative Scoliosis Associated With Lumbar Stenosis

Abstract

Adult degenerative scoliosis associated with lumbar stenosis has become a common issue in the elderly population. But its surgical management is on debating. The main issue condenses on the management priority of scoliosis or stenosis. This study is to investigate surgical management strategy and outcome of adult degenerative scoliosis associated with lumbar stenosis. Between January 2003 and December 2010, 108 patients were admitted to the authors' institution for adult degenerative scoliosis associated with lumbar stenosis. They were divided into 3 groups based on the symptom. Then the surgical management was carried out. The clinical outcome was evaluated according to the Oswestry Disability Index (ODI) and Scoliosis Research Society-22 score (SRS-22 score) at follow up. Group 1 was with primary lumbar stenosis symptom, local decompression and short fusion were performed. Group 2 was with compensated spinal imbalance symptom, local decompression of the symptomatic spinal stenosis and short fusion were performed. Group 3 was with primary spinal imbalance, correction surgery and long fusion were performed. For Group 1, the ODI scores declined from 62.5 ± 4.2 preoperatively to 21.8 ± 2.5 at final follow up, the SRS-22 scores decreased from 44.8 ± 3.2 preoperatively to 70.9 ± 6.0 at final follow up. For Group 2, the ODI and SRS-22 scores were 73.4 ± 8.4 and 40.8 ± 8.5 before the surgery, declined to 22.4 ± 4.2 and 73.2 ± 7.9 at final follow up. For Group 3, the ODI and SRS-22 scores were 73.4 ± 4.9 and 45.3 ± 6.4 before surgery, declined to 30.4 ± 8.9 and 68.8 ± 8.1 at final follow up. It was effective to perform decompression and short fusion for Group 1 and correction surgery and long fusion for Group 3. For Group 2, the compensated imbalance symptom was always provoked by the symptomatic lumbar stenosis. The cases in the Group 2 got well clinical improvements after local surgical intervene on the symptomatic spinal stenosis and short fusion, leaving the deformity untreated.

FIGURE 1

(A) The patient could stand erectly without any support. She belonged to Group 1. Figures (B/C) showed a well sagittal balance. (D/E) The patient underwent a 2-level decompression and fusion. Transforaminal lumbar intervertebral fusion was performed. Good sagittal balance was maintained.

FIGURE 2

(A/B) A 65-year-old female patient belonged to Group 2, with a lumbar curve as 30°, lumbar lordosis as 15°, thoracic lordosis as 5°. (C) Magnetic resonance imaging showed disc hernia occurred at L2/3 and L3/4. (D/E) The patient underwent decompression and 2 levels fusion (TLIF). (F/G) At 3-year follow-up, the balance was well maintained. TLIF = transforaminal lumbar intervertebral fusion.

FIGURE 3

(A/B) A 55-year-old female patient belonged to Group 3. The lumbar curve was 22°, the lumbar kyphosis was 20°. (C) Magnetic resonance imaging showed spinal stenosis occurred at L3/4, 4/5, L5/S1. (D/E) The patient underwent correction and long fusion from L2 to S1. The lumbar curve was 6°, lumbar lordosis was 18° at the final follow-up.