Adult idiopathic de novo lumbar scoliosis: Analysis of surgical treatment in 14 patients by "only fixation"

Abstract

Objective: The authors report their experience with 14 cases having adult idiopathic de novo lumbar scoliosis (AIDLS) and presenting with the predominant symptoms of claudication pain in the low back and legs. The patients were treated by only multisegmental stabilization, and the surgical procedure aimed for arthrodesis without any form of bone or soft-tissue decompression. The clinical outcome of this novel form of surgical treatment is presented.

Materials and methods: During the period of June 2014 to June 2019, 14 patients having AIDLS (degenerative scoliosis) were surgically treated. Apart from clinical and radiological guides, instability was diagnosed on the basis of direct physical observation of the status of articulation and by manual manipulation of bones of the region. The Camille transarticular facet screw fixation technique provided a quick, safe, and strong segmental spinal fixation. An additional inter-screw metal link plate provided intersegmental stability at selected levels. The Oswestry Disability index and visual analog scale were used to assess the patients before and after surgery and at follow-up. In addition, a personalized Patient Satisfaction Score was used to assess the outcome of surgery.

Results: Clinical symptomatic recovery was observed in all patients in the immediate postoperative period. During the average follow-up period, 100% patients had varying degrees of symptomatic relief.

Conclusions: Spinal instability is the nodal point of pathogenesis of spinal degeneration-related AIDLS. Only fixation of the involved spinal segments is necessary, and decompression by bone or soft-tissue resection is not necessary.

Keywords: Lumbar canal stenosis; lumbar scoliosis; spinal degeneration; transarticular screw fixation.

Figure 1

Images of a 56-year-old female patient:(a) T2-weighted magnetic resonance imaging shows multisegmental lumbar dural tube compression by varying sizes of osteophytes. (b) Computed tomography scan shows varying sizes of anterior and posterior osteophytes. (c) Anteroposterior view of computed tomography scan showing lumbar scoliosis. Large lateral osteophytes are seen on the concave side of the scoliosis curve. (d) Three-dimensional computed tomography scan of the lumbosacral spine showing the spinal deformity. (e) Anteroposterior view of the plain radiograph. (f) Postoperative computed tomography scan of the lumbar spine. (g) Computed tomography scan cut showing transarticular facet fixation. A cross-link plate and screw fixation can be seen. (h) Postoperative radiograph showing the reduction in the scoliosis. Metal implants can be seen