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SEATTLE — A majority of adults with degenerative lumbar scoliosis experienced pain relief after undergoing posterior decompression and fusion, according to a 42-patient study presented at the annual meeting of the North American Spine Society.
At an average follow-up of just over 4 years, 95% of patients reported excellent or good relief of leg pain, and nearly 90% had the same response when asked about back pain. In addition, 86% felt there was improvement in their lifestyle postoperatively, said Dr. Christopher Furey.
“Pain, function, image, and quality of life were all significantly improved, and 80% of patients felt their preoperative expectations had been met or exceeded,” said Dr. Furey, of the department of orthopedic surgery at Case Western Reserve University in Cleveland.
This type of repair is a major undertaking, he said. “Adults with degenerative lumbar scoliosis frequently have significant medical issues—including osteopenia and osteoporosis—that make them more of a challenge. These are lengthy surgeries with the potential for significant blood loss and long hospital stay, and complications are common,” Dr. Furey explained.
All patients in this retrospective analysis were first treated conservatively, and only those who were ready to proceed with elective surgery underwent decompression and fusion with pedicle screw instrumentation and iliac crest graft.
All levels with spinal stenosis were decompressed, including bilateral foraminotomies. All levels decompressed were fused, as were any levels with lateral listhesis greater than 6 mm. The proximal extent of the fusion was at the lowest neutral vertebra in the upper lumbar or lower thoracic spine. Fusion was extended to the sacrum only if an L5-S1 spondylolisthesis was present, but otherwise was stopped at L5, Dr. Furey said.
Two patients developed deep infections that required surgical debridement, and misplaced pedicle screws in two others had to be adjusted, he said. “Excluding those who had immediate postoperative treatment for infections, there was a 21% reoperation rate, which is high.”
Dr. Furey and his coauthor, Dr. Sanford Emery of West Virginia University, Charleston, said that because the procedure potentially can cause significant complications in older patients, it should be reserved for those who have failed conservative management and who are suitable medical candidates. “These patients deserve respect, and optimizing medical issues—including good intraoperative anesthesia support and postoperative observation—is critical,” Dr. Furey said.
SEATTLE — A majority of adults with degenerative lumbar scoliosis experienced pain relief after undergoing posterior decompression and fusion, according to a 42-patient study presented at the annual meeting of the North American Spine Society.
At an average follow-up of just over 4 years, 95% of patients reported excellent or good relief of leg pain, and nearly 90% had the same response when asked about back pain. In addition, 86% felt there was improvement in their lifestyle postoperatively, said Dr. Christopher Furey.
“Pain, function, image, and quality of life were all significantly improved, and 80% of patients felt their preoperative expectations had been met or exceeded,” said Dr. Furey, of the department of orthopedic surgery at Case Western Reserve University in Cleveland.
This type of repair is a major undertaking, he said. “Adults with degenerative lumbar scoliosis frequently have significant medical issues—including osteopenia and osteoporosis—that make them more of a challenge. These are lengthy surgeries with the potential for significant blood loss and long hospital stay, and complications are common,” Dr. Furey explained.
All patients in this retrospective analysis were first treated conservatively, and only those who were ready to proceed with elective surgery underwent decompression and fusion with pedicle screw instrumentation and iliac crest graft.
All levels with spinal stenosis were decompressed, including bilateral foraminotomies. All levels decompressed were fused, as were any levels with lateral listhesis greater than 6 mm. The proximal extent of the fusion was at the lowest neutral vertebra in the upper lumbar or lower thoracic spine. Fusion was extended to the sacrum only if an L5-S1 spondylolisthesis was present, but otherwise was stopped at L5, Dr. Furey said.
Two patients developed deep infections that required surgical debridement, and misplaced pedicle screws in two others had to be adjusted, he said. “Excluding those who had immediate postoperative treatment for infections, there was a 21% reoperation rate, which is high.”
Dr. Furey and his coauthor, Dr. Sanford Emery of West Virginia University, Charleston, said that because the procedure potentially can cause significant complications in older patients, it should be reserved for those who have failed conservative management and who are suitable medical candidates. “These patients deserve respect, and optimizing medical issues—including good intraoperative anesthesia support and postoperative observation—is critical,” Dr. Furey said.
SEATTLE — A majority of adults with degenerative lumbar scoliosis experienced pain relief after undergoing posterior decompression and fusion, according to a 42-patient study presented at the annual meeting of the North American Spine Society.
At an average follow-up of just over 4 years, 95% of patients reported excellent or good relief of leg pain, and nearly 90% had the same response when asked about back pain. In addition, 86% felt there was improvement in their lifestyle postoperatively, said Dr. Christopher Furey.
“Pain, function, image, and quality of life were all significantly improved, and 80% of patients felt their preoperative expectations had been met or exceeded,” said Dr. Furey, of the department of orthopedic surgery at Case Western Reserve University in Cleveland.
This type of repair is a major undertaking, he said. “Adults with degenerative lumbar scoliosis frequently have significant medical issues—including osteopenia and osteoporosis—that make them more of a challenge. These are lengthy surgeries with the potential for significant blood loss and long hospital stay, and complications are common,” Dr. Furey explained.
All patients in this retrospective analysis were first treated conservatively, and only those who were ready to proceed with elective surgery underwent decompression and fusion with pedicle screw instrumentation and iliac crest graft.
All levels with spinal stenosis were decompressed, including bilateral foraminotomies. All levels decompressed were fused, as were any levels with lateral listhesis greater than 6 mm. The proximal extent of the fusion was at the lowest neutral vertebra in the upper lumbar or lower thoracic spine. Fusion was extended to the sacrum only if an L5-S1 spondylolisthesis was present, but otherwise was stopped at L5, Dr. Furey said.
Two patients developed deep infections that required surgical debridement, and misplaced pedicle screws in two others had to be adjusted, he said. “Excluding those who had immediate postoperative treatment for infections, there was a 21% reoperation rate, which is high.”
Dr. Furey and his coauthor, Dr. Sanford Emery of West Virginia University, Charleston, said that because the procedure potentially can cause significant complications in older patients, it should be reserved for those who have failed conservative management and who are suitable medical candidates. “These patients deserve respect, and optimizing medical issues—including good intraoperative anesthesia support and postoperative observation—is critical,” Dr. Furey said.