Individualized surgical therapy for degenerative lumbar scoliosis with stenosis
CHEN Ming
FAN Hai-quan
JIANG Yang
HUANG Hai-xun
YU Yang
Abstract：Objective To investigate the therapeutic outcomes of selective decompression and fusion for degenerative lumbar scoliosis with stenosis ( DLSS ). Methods From February 2007 to January 2011, 28 patients with DLSS underwent posterior surgery. There were 11 males and 17 females, whose average age was 67.3 years old ( range:54-73 years ). The course of disease lasted from 4 to 8 years. Preoperatively the mean Cobb’s angle was 31° ( range:15°-49° ), and the mean lordosis angle ( T12-S1 ) was-10.5° ( range:-30.6°-3.3° ). Selective spinal canal or nerve root canal decompression was performed on 5 patients with the Cobb’s angle<20°, who then received posterior lumbar interbody fusion and short-segment pedicle instrumentation. Twenty-three patients with the Cobb’s angle>20° underwent spinal canal decompression, long-segment pedicle instrumentation, scoliosis correction, posterior lumbar interbody fusion and posterolateral autograft bone fusion. The clinical outcomes were evaluated by Visual Analogue Scale ( VAS ) scores and Japanese Orthopedic Association ( JOA ) scores. The Medical Outcomes Study 36-item short-form health survey ( SF-36 ) was used to assess the patients’ quality of life before the operation and in the latest follow-up. Results Decompression was performed on 113 segments and fusion on 90 segments in 28 patients. The average number of decompressed segments was 4.0 and the average number of fused segments was 3.2. The mean follow-up period was 32 months ( range:24-70 months ). The mean surgery time was ( 3.5±0.5 ) h, and the mean blood loss was ( 600±30 ) ml. In the latest follow-up, the VAS scores of low back and leg pain were obviously decreased when compared with the preoperative VAS scores ( P<0.05 ). The preoperative Cobb’s angle was 31° on average, which was corrected to 15.2° postoperatively, and the mean correction rate was 51.0%. The lordosis angle was corrected to 18.4° on average ( range:5.4°-28.2° ). Both the lordosis angle and Cobb’s angle were obviously improved ( P<0.05 ). The average JOA score was 13.6 points preoperatively and 27.5 points in the latest follow-up ( P<0.05 ). All the patients’ quality of life was significantly improved. The scores of all the 8 SF-36 domains were significantly improved postoperatively ( P<0.05 ). Conclusions An individualized surgical therapy should be chosen for DLSS. Decompression is given priority and fusion is complementary, when the surgical plan is designed. The responsible segment should be judged accurately. The clinical outcomes are satisfactory, and the patients’ quality of life is signiifcantly improved.
Keywords：Spinal stenosisScoliosisSpinal fusionLumbar vertebraeSpine
Publication Date：2014-01-01
Pages：4( 931-934 )