Analysis of related risk factors for the refracture of adjacent vertebral body after percutaneous kyphoplasty / 中国骨伤

OBJECTIVE@#To investigate the risk factors of vertebral refracture after percutaneous kyphoplasty (PKP) for osteoprotic vertebral compression fractures (OVCFs), and to provide reference for clinical prevention.@*METHODS@#A retrospective analysis of 228 OVCFs patients who met the inclusion criteria admitted from November 6, 2013 to December 14, 2018. There were 35 males and 193 females, with a male-to-female ratio of 3∶20, and aged 58 to 91 years with an average of (69.70±7.03) years. All patients were treated with PKP and had complete clinical data. According to whether refracture occurred after operation, they were divided into refracture group (24 cases) and non refracture group (204 cases). Factors that may be related to refracture (including gender, age, surgical segment, number of vertebral bodies in the surgical segment, whether combined with degenerative scoliosis, whether anti-osteoporosis treatment) were included in the univariate analyses, and the single factor analysis of statistically significant risk factors was carried out with multiple Logistic regression analysis to further clarify the independent risk factors for vertebral body refracture after PKP. Survival analysis was performed using the time of vertebral refracture after PKP as the end time of follow up, the occurrence of refracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor.@*RESULTS@#All 228 patients were followed up for 1.8 to 63.6 months with an average of (28.8±15.6) months, and the refracture rate was 10.5%(24/228). There were statistically significant differences between two groups in age, number of operative vertebral bodies, whether combinedwith degenerative scoliosis and whether anti osteoporosis treatment (@*CONCLUSION@#Combined scoliosis is an independent risk factor for refracture after OVCFs vertebroplasty, and it is also a possible high-risk factor for refracture after surgery.

Clinical efficacy and complications of short versus long segments of internal fixation for the treatment of degenerative scoliosis: A meta-analysis / 中国组织工程研究

BACKGROUND: Currently, surgical methods for the treatment of degenerative scoliosis include simple decompression and decompression combined with internal fixation. However, there is still controversy over the choice of fixation and fusion segment in surgery, which requires more reliable evidence-based medical evidence for reference. OBJECTIVE: To evaluate the clinical efficacy and complication of short versus long segments of internal fixation for the treatment of degenerative scoliosis using meta-analysis. METHODS: CNKI, Wanfang Database, VIP, CBM, EMBase, PubMed, Web of Science, and Cochrane Library were searched to collect the randomized and non-randomized controlled studies which compared long fusion with short fusion in the treatment of degenerative scoliosis from inception to February 2019. Relevant conference papers and authoritative journals in the field were retrieved manually. The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard or the Newcastle-Ottawa Scale. The included studies were analyzed by using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 20 articles were included, involving a sample of 1 329 individuals. Long segment group consisted of 601 cases, and short segment group consisted of 728 cases. (2) The meta-analysis results showed that long-segment internal fixation surgery had better improvement of coronal Cobb angle (P=0.000 4), coronal balance (P=0.000 2), Oswestry disability index (P=0.003) and visual analogue scale score (P 0.05). (4) These findings verify that long-segment internal fixation is superior to short-segment internal fixation in the correction of scoliosis, but the recovery is slow and the incidence of some complications after operation is high. It should be considered comprehensively when selecting specific surgical procedures.

Related factors and biomechanical characteristicsof lumbar facet joint degeneration / 中国组织工程研究

BACKGROUND: Lumbar facet joint degeneration has become the focus of scholars’ research in recent years. Understanding the risk factors of lumbar facet joint degeneration plays a key role in preventing and reducing the damage to spine health. Moreover, comprehending its anatomy has important guiding significance for the treatment of spine-related diseases and related operations. OBJECTIVE: To briefly describe the anatomy and histological characteristics of the lumbar facet joints, and summarize the risk factors of lumbar facet joints degeneration. METHODS: A computer-based search of CNKI, Wanfang database, VIP database, PubMed, Elsevier and Web of Science was performed with the search terms “lumbar facet joint, joint capsule, articular direction, eneurosis, osteoarthritis, biomechanics, low back pain, intervertebral disc degeneration, lumbar spondylolisthesis, lumbar degenerative scoliosis” for articles published from March 2018 to September 2019. Review, basic research and clinical research were screened by reading title and abstract. The studies with low relevance to the subject were excluded, and 60 studies were included in the final analysis. RESULTS AND CONCLUSION: (1) The main risk factors for lumbar facet joint degeneration include age, gender, abnormal stress, articular surface orientation, joint asymmetry, lumbar segment and disc degeneration. (2) When the joints degenerate, it can cause low back pain, disc degeneration, lumbar spondylolisthesis, degenerative scoliosis and other clinical diseases, which seriously affect people’s daily life and work, and reduce people’s living quality. Therefore, lumbar facet joints should not be ignored in the treatment of spine-related diseases.

Effectiveness of short fusion versus long fusion for degenerative scoliosis with a Cobb angle of 20-40° combined with spinal stenosis / 中国修复重建外科杂志

Objective: To compare the effectiveness of decompression and short fusion or long fusion for degenerative scoliosis (DS) with a Cobb angle of 20-40° combined with spinal stenosis. Methods: The clinical data of 50 patients with DS who were treated with decompression combined with short fusion or long fusion between January 2015 and May 2017 were retrospectively analysed. Patients were divided into long fusion group (fixed segments>3, 23 cases) and short fusion group (fixed segments≤3, 27 cases). There was no significant difference in gender, age, disease duration, and preoperative visual analogue scale (VAS) score of leg pain, Oswestry disability index (ODI), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), pelvic incidence (PI), pelvic title (PT), and sacral slope (SS) between the two groups ( P>0.05); however, the VAS score of low back pain, Cobb angle, and sagittal vertical axis (SVA) in long fusion group were significantly higher than those in short fusion group ( P0.05). The Cobb angle, SVA, TLK, and PT significantly decreased, while SS and LL significantly increased in the long fusion group ( P0.05). The improvements of Cobb angle, SVA, LL, PT, and SS in the long fusion group were significantly higher than those in the short fusion group at last follow-up ( P<0.05). There was no perioperative death in both groups. The incidence of complications in the long fusion group was 34.8% (8/23), which was significantly higher than that in the short fusion group [11.1% (3/27)] ( χ2=4.056, P=0.034). Conclusion: The DS patients with the Cobb angle of 20-40°can achieve satisfactory clinical outcomes and improve the spino-pelvic parameters by choosing appropriate fixation levels. Short fusion has less surgical trauma and fewer complications, whereas long fusion has more advantages in enhancing spino-pelvic parameters and relieving low back pain.

Short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis / 中华医学杂志(英文版)

Background@#The effect of short-segment decompression/fusion versus long-segment decompression/fusion and osteotomy for Lenke-Silva type VI adult degenerative scoliosis (ADS) has not been clarified. This study aimed to compare the clinical and radiographic results of short-segment fusion vs. long-segment fusion and osteotomy for patients with Lenke-Silva type VI ADS.@*Methods@#Data of 28 patients who underwent spinal surgery for ADS from January 2012 to January 2014 in the General Hospital of Northern Theater Command were reviewed. Of the 28 patients, 12 received long-segment fusion and osteotomy and 16 received short-segment fusion. Radiographic imaging parameters and clinical outcomes, including the sagittal vertical axis (SVA), lumbar lordosis (LL) angle, pelvic tilt (PT), sacral slope (SS), the visual analog scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and lumbar stiffness disability index (LSDI) scores, were recorded. The difference between groups was compared using the dependent t test or Chi-squared test.@*Results@#The Cobb and LL angles and SVA improved in both groups; however, PT and SS angles did not improve following short fusion. There were significant differences in the post-operative SVA (26.8 ± 5.4 mm vs. 47.5 ± 7.6 mm, t = -8.066, P < 0.001), PT (14.7 ± 1.8° vs. 29.1 ± 3.4°, t = -13.277, P < 0.001), and SS (39.8 ± 7.2° vs. 26.1 ± 3.3°, t = 6.175, P < 0.001) between the long and short fusion groups. All patients had improved ODI, JOA, and VAS scores post-operatively (all P < 0.001), with no significant difference between the groups (all P > 0.05). The post-operative LSDI score was 3.5 ± 0.5 in the long fusion group, which was significantly higher than that of the short fusion group (1.4 ± 0.7; P < 0.001).@*Conclusions@#The clinical outcomes of patients with Lenke-Silva type VI ADS who underwent short-segment decompression/fusion were comparable to those of patients who underwent long-segment decompression/fusion and osteotomy despite poor correction of sagittal imbalance. Moreover, short-segment decompression/fusion showed a short operation time and reduced surgical trauma.

Relación entre la degeneración discal y la inestabilidad lumbar / Relations between disc degeneration and lumbar instability

Introducción: La inestabilidad lumbar es una de las causas más frecuentes del dolor en la espalda. Las dificultades para el diagnóstico provocan que su incidencia sea menor de lo esperado en la práctica clínica y dificultan su tratamiento. Objetivo: Evaluar lo publicado relativo al proceso de degeneración discal, así como su influencia sobre la estabilidad de la columna lumbar. Métodos: Se revisaron los principales avances relacionados con la degeneración discal que guardan relación con la inestabilidad vertebral lumbar. Se consultaron artículos publicados en PubMed, en idioma inglés, desde 2012 hasta 2017. Se examinaron artículos accesibles de forma libre o a través de Clinical Key e Hinari. Se tuvieron en cuenta algunos artículos que sobrepasan los cinco años de antigüedad, pero que son claves en el tema. Resultados: Dos procesos afectan al disco intervertebral lumbar como consecuencia del envejecimiento y la degeneración: espondilosis deformante y osteocondrosis intervertebral. Los cambios degenerativos están relacionados con el tiempo. Se pueden diferenciar tres fases que, a manera de cascada, desencadenan trastornos del movimiento e inestabilidad. Conclusiones: Los cambios degenerativos vertebrales producen aumento de la movilidad segmentaria (posible causa de inestabilidad lumbar). La zona neutra es un parámetro solo medible in vitro. No existe una prueba que permita confirmar el diagnóstico de inestabilidad vertebral. Los hallazgos clínicos y por imágenes constituyen la mejor recomendación para llegar al diagnóstico. El concepto de inestabilidad vertebral lumbar y su tratamiento, a través de la fusión vertebral, no están suficientemente justificados(AU)

Introduction: Lumbar instability is one of the most frequent causes of back pain. Difficulties in diagnosis result its incidence to be lower than expected in clinical practice and make it difficult to treat. Objective: To characterize and evaluate what is published regarding the process of disc degeneration, as well as its influence on the stability of the lumbar spine. Methods: We reviewed the main advances related to disc degeneration that cause vertebral instability. Articles published in PubMed, in English, from 2012 to 2017 were consulted. Articles in open access or through Clinical Key and Hinari were studied. Some articles older than 5 years were taken into account, because they are relevant to the subject. Results: Two processes affect the lumbar intervertebral disc because of aging and degeneration: deforming spondylosis and intervertebral osteochondrosis. The degenerative changes occur related to time and three phases can be differentiated that cascade triggers movement disorders and instability. Conclusions: Vertebral degenerative changes produce increased segmental mobility, a possible cause of lumbar instability. The neutral zone is a parameter only measurable "in vitro". There is no evidence to confirm the diagnosis of vertebral instability. Clinical and imaging findings are the best recommendation to reach to a diagnosis. The concept of lumbar vertebral instability and its treatment through vertebral fusion are not sufficiently justified(AU)

Introduction: L'instabilité lombaire est l'une des causes les plus fréquentes du mal au dos. Son diagnostic s'avère difficile, ce qui provoque une incidence plus faible qu'attendu dans la pratique clinique, et empêche son traitement. Objectif: Évaluer tout ce qui a été publié en relation avec le processus de dégénérescence discale, ainsi que son influence sur la stabilité de la colonne lombaire. Méthodes: Une revue des principales avancées relatives à la dégénérescence distale qui sont en rapport avec l'instabilité vertébrale lombaire a été effectuée. On a consulté des articles publiés sur PubMed, en langue anglaise, depuis 2012 jusqu'à 2017. On a examiné des articles accessibles de manière libre ou à travers Clinical Key et Hinari. Si bien que certains articles surpassaient les cinq ans de publication, ils ont été pris en compte, parce qu'ils étaient essentiels pour ce thème. Résultats: Deux processus affectent le disque intervertébral lombaire comme conséquence du vieillissement et de la dégénérescence -la spondylose déformante et l'ostéochondrose intervertébrale. Les changements dégénératifs sont en relation avec le temps. On peut distinguer trois phases qui, en guise de cascade, déclenchent les troubles du mouvement et l'instabilité. Conclusion: Les changements dégénératifs vertébraux entrainent une augmentation de la mobilité segmentaire (possible cause d'instabilité lombaire). La zone neutre est un paramètre qui ne peut être mesuré qu'in vitro. Il n'existe aucune preuve permettant de confirmer le diagnostic d'instabilité vertébrale. Les constatations cliniques et par imagerie constituent la meilleure recommandation pour aboutir à un diagnostic. La notion d'instabilité vertébrale lombaire et son traitement, à travers la fusion vertébrale, ne sont pas suffisamment justifiés(AU)

Epidemiological and radiological profile of patients with degenerative scoliosis: 20 year experience at a referral institute / Perfil epidemiológico y radiológico de pacientes con escoliosis degenerativa: 20 años de experiencia en un Instituto de referencia

Abstract: Background: Adult degenerative scoliosis is a complex three-dimensional rotational deformity, in a previously straight spine, resulting in sagittal and axial disbalance. Material and methods: This retrospective study presents the casuistry of patients 40 to 80 years old with adult degenerative scoliosis who underwent surgery in a referral institute from January 1994 to December 2013. Results: The prevalence was 0.087% (CI 95% 67.8-111), with a median age of 64.9 ± 9.4 years old, increased frequency in women and older adults. The prevalence of spondylolisthesis associated with degenerative scoliosis was 21%. The estimated risk for scoliosis in women was OR = 2.37 (CI 95% 1.35-4.15), while men showed OR = 0.4 (CI95% 0.24-0.73). The risk for spondylolisthesis associated to degenerative scoliosis was in men OR = 1.87. Conclusions: The prevalence in our experience is low and the sample age was higher; while gender, severity of the curve and presence of spondylolisthesis and olistesis were similar to the reviewed literature.

Resumen: Antecedentes: La escoliosis degenerativa del adulto es una deformidad rotacional tridimensional compleja, en una columna recta previamente, dando por resultado desequilibrio sagital y axial. Material y métodos: Este estudio retrospectivo presenta la casuística de los pacientes de 40 a 80 años de edad con escoliosis degenerativa del adulto que experimentaron la cirugía en un instituto de referencia desde enero de 1994 a diciembre de 2013. Resultados: La prevalencia fue de 0.087% (IC 95% 67.8-111), con una edad media de 64.9 ± 9.4 años, mayor frecuencia en mujeres y adultos mayores. La prevalencia de la espondilolistesis asociada a escoliosis degenerativa fue de 21%. El riesgo estimado para la escoliosis en las mujeres fue = 2.37 (IC 95% 1.35-4.15), mientras que los hombres mostraron OR = 0.4 (IC95% 0.24-0.73). El riesgo de espondilolistesis asociada a escoliosis degenerativa fue en hombres OR = 1.87. Conclusiones: La prevalencia en nuestra experiencia es baja y la edad de la muestra fue mayor; mientras que el género, la gravedad de la curva y la presencia de espondilolistesis y olistesis eran similares a la literatura consultada.

RESEARCH PROGRESS OF SURGICAL SELECTION OF FUSION LEVELS FOR DEGENERATIVE SCOLIOSIS / 中国修复重建外科杂志

OBJECTIVE: To summarize the progress of the surgical selection of fusion levels for degenerative scoliosis.

Effect of Rehabilitation on Degenerative Scoliosis after Operation / 中国康复理论与实践

@#ObjectiveTo observe the clinical effect of the rehabilitation on the degenerative scoliosis after the interbody fusion and internal fixation.Methods50 patients with degenerative scoliosis and received the interbody fusion and pedicle screw fixation were divided into the rehabilitation group and the control group. Results2 months after operation, the scoliosis coronal Cobb's angle were corrected from (34.11±9.36)° before operation to (23.08±9.16)°. 3 months after operation, the scores of JOA scale, the investigation of quality of life and satisfaction all resulted in better outcome in the rehabilitation group than the control group. ConclusionThe rehabilitation training after operation can reduce complications and improve the quality of life.

Extreme lateral interbody fusion for degenerative scofiosis / 中华显微外科杂志

@#Objective To introduce extreme lateral interbody fusion (XLIF) as a new minimally inva-sire spinal surgery with established correction and fusion methods to assess its clinic use for degenerative scoliosis. It is emphasized the value and highlight of this technique in spinal surgery. Methods Surgical treatment of 8 patients with degenerative scoliosis were performed with XLIF between March 2006 and April 2008. In this group of patients, 5 cases provided an anterior cage in every disc space, and another 3 supplemented with vertebrae screw fixation. Blood loss was 50 ml every procedure. To observe the low back pain, corrective rate, achieving a balanced and complications. Results The low back pain have been relieved in all patienta after operations, the disc height can be restored, allowing more room at the foraminal level for nerve roots, and lumber lordosis can be maintained. Corrective rate was 64%, there wasn't neurologic and vascular injury, 2 case had correction loss a little postoperation 6-30 month. Conclusion The potential benefits of XLIF include safe, effective, less approach-related blood loss, improved cosmetic result with smaller incisions, and reduced hospital stay for degenerative scoliosis.

Selective Pedicle Screw Fixation with Long Fusion in the Treatment of Spinal Stenosis with Degenerative Scoliosis / 대한척추외과학회지

STUDY DESIGN: This retrospective study was designed to evaluate treatment options for spinal stenosis with degenerative scoliosis. PURPOSE: To evaluate the clinical outcomes based on the degree of spinal deformity for selective pedicle screw fixation with a long fusion for spinal stenosis with degenerative scoliosis. MATERIALS AND METHODS: We reviewed 54 cases performed from March 1996 to March 2006, and divided them into three groups based on osteophyte formation, pedicular rotation, and lateral transition. The three groups were analyzed for degree of correction of scoliotic and lordotic angle and bone fusion rate, as well as radiographically and clinically using the Kirkaldy-Willis questionnaire. RESULTS: Mild or moderate deformities (49 cases) were improved an average of 3 degrees of scoliotic angle, grade 1 of pedicular rotation, and 1 mm of lateral transition and were satisfied clinically. Severe deformities (5 cases) improved an average of 8 degrees of scoliotic angle, grade 2 of pedicular rotation, and 3 mm of lateral transition, but were clinically unsatisfactory. There was insignificant correction of the lordotic angle in all deformities and a fusion rate of 81.5% in mild-to-moderate deformities and 40% in severe deformities. CONCLUSION: Selective pedicle screw fixation with a long fusion for spinal stenosis with degenerative scoliosis is a treatment option for mild to moderate deformities.

Surgical treatment of lumbar scoliosis in elderly patients over 65 years / 中国矫形外科杂志

[Objective]To evaluate the surgical results of spinal scoliosis in the elderly and to investigate the indications,surgical techniques and factors which may contribute to the outcome. [Methods]A retrospective study was held.Sixty-four patients≥65 years undergoing different kinds of operation for lumbar spinal scoliosis from Sep.2004 to Apr.2008 were recruited.The mean patient age at surgery was 69.2 years(61~75 years).[Results]There were a variety of treatment methods of degenerative scoliosis based on symptomatology and radiologic measurements of scoliosis and stenosis.Sixty-four patients were followed up for an average of 37 months.The average correction rate of scoliosis was 51.2% after operation.No case was found spinal cord injury.Clinical symptoms and functional tolerance for daily activities improved after surgery.Radiographic evaluation showed a reduction in the deformity on the frontal and sagittal planes.There were no infections,pseudoarthrosis,instrument related failures or reoperations in this series.[Conclusion]The surgical results of lumbar scoliosis in the elderly are better than to those reported for the general population.Carefully perioperative preparation is very important in the treatment of elderly patients with lumbar spinal scoliosis.

Surgical treatment of the lumbar degenerative de novo scoliosis combined with vertebral stenosis / 中国矫形外科杂志

[Objective]To explore the surgical plan of lumbar degenerative de novo scoliosis combined with vertebral stenosis(LDDS) and evaluate the surgical efficiency.[Method]From July 2003 to Jan.2007,32 LDDS patients were diagnosed and operated in the author’s hospital.The X-ray,computed tomography and MRI radiological data were measured carefully preoperately which included the Cobb’s angle,vertebral rotational and lateral subluxation degree.All the patients were treated by posterior decompression and pedicle screw internal fixation,and the surgery,fluoroscopic time and bleeding amount were recorded.Patients were administered pre- and postoperatively with clinical outcome surveys of Visual Analogue Pain Score(VAS),Low Back Outcome Score(LBOS).Pre- and postoperative measurements of the Cobb's angle and lumbar lordosis of the involved segments were analyzed.[Result]The surgery time was 4?0.5 hours,the average bleeding amount was 400?30 ml,the fluoroscopic time was 30?5 min.All the patients were followed from 8 months to 4 years,and radiography was proceeded on 8 and 16 months respectively post surgery.Twenty-four cases got good bone fusion,and mean Cobb's angle decreased from 37.2 to 18.4 degrees,mean focal lordosis increased from 13.1 to 16.4 degrees,mean vertebral rotation angle decreased from 14.2 to 9.8 degrees,mean preoperative measures of VAS and LBOS improved from 5.3?2.2 and 24.8?15.6,respectively to 2.2?2.1 and 44.8?18.0 at last follow-up,the Cobb’s angle,lumbar lordosis and the degree of vertebral rotation had significantly difference pre and post surgery(t test,P

The Relationship between Sagittal Spinal Alignment and Surgical Results in Degenerative Lumbar Scoliosis with Spinal Stenosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the correlation between clinical results and sagittal vertical axis, clinical results and total lumbar lordosis in degenerative lumbar scoliosis with spinal stenosis. SUMMARY OF LITERATURE REVIEW: There has been no report about the relation between sagittal spinal alignment and surgical outcome of degenerative lumbar scoliosis. MATERIALS AND METHODS: We reviewed 38 surgical cases of degenerative lumbar scoliosis from February 1997 to February 2001 with an average follow-up of 35 months. In whole spine standing AP and lateral radiographs, scoliotic angle(Cobb method), total lumbar lordosis(L1-S1) and the sagittal vertical axis(C7 plumb line) were measured. In lumbar flexion-extension and standing side bending views, the lateral translation was measured and instability was determined. Clinical results were evaluated based on the Kirkaldy-Willis criteria. RESULTS: The scoliotic angles at preoperative, postoperative and follow-up were 15.0+/-4.9, 5.3+/-3.1 and 7.1+/-3.7 degrees retro-spectively. Total lumbar lordosis were 28.7+/-6.1, 40.6+/-7.3 and 35.1+/-10.2 degrees retrospectively. Sagittal vertical axis at preoperative and the last follow-up were 3.3+/-3.2 and 0.1 +/-3.3 cm retrospectively. According to Kirkaldy-Willis criteria, 6 cases were excellent, 24 cases good, 7 cases fair and 1 case poor. There was no statistical correlation between total lumbar lordosis and the clinical results (r=-0.061, p=0.717). Sagittal vertical axis was significantly correlated with the clinical results (r=0.519, p=0.001). CONCLUSIONS: For improvement of surgical outcome of degenerative lumbar scoliosis, the sagittal vertical axis should be used as a parameter of sagittal alignment rather than the total lumbar lordosis.

Operative Treatment of Degenerative Scoliosis / 대한척추외과학회지

STUDY DESIGN: The retrospective study was designed to propose treatment options of degenerative scoliosis OBJECTIVES: To propose various treatment options based on patients'clinical symptoms & radiologic findings and finally to get a standard treatment options. SUMMARY OF LITERATURE REVIEW: The studies about the treatment options of degenerative scoliosis were few, so we propose the treatment options of degenerative scoliosis. MATERIALS & METHODS: Between January, 1994 and August, 2000, 136 cases of degenerative scoliosis were diagnosed. Among these cases, 45 cases (33%) were performed operative treatment. There were 45 women and 4 men. The average patients age was 62.6 years (range 43~78years). The average follow up time was 23 months (range 12 mon~66 months). Scoliotic angle within curve was measured by Cobb's methods, and rotation of pedicles were measured by Nash and Moe methods. RESULTS: The overall satisfactory clinical results was noted in 37 (82%) of 45 patients. By Kirkardy-Willis questionnaire, 14 cases were excellent, 23 cases were good, 5 cases were fair, 3 cases were poor. Before surgery, average Cobb's angle measured 16 degree (range 7~44 degree), after surgery, this corrected to 9.2 degree (range 2~25 degree). But, degree of improvement in Cobb's angle and one of clinical symptom relief had no statistic correlations (p>0.05). CONCLUSION: 1) When neurologic symptoms were chief complaints, and scoliosis curvature was stable. only decompression surgery should be performed. 2) when mild back pain and neurologic symptoms were chief complaints, and rotatory subluxation at stenotic level, decompression & limited post. instrumentation & fusion. 3) when severe back pain and neurologic symptoms were chief complaints, and scoliosis curvature was unstable, decompression & long post. instrumentation & fusion. 4) When only technical pain-no neurologic symptoms-was a chief complaints, correction & fusion with instrumentation.

Posterior Lumbar Interbody Fusion in Multilevel Lumbar Spinal Stenosis Associated with Degenerative Scoliosis / 대한척추외과학회지

STUDY DESIGN: In this study, 18 patients undergoing posterior lumbar interbody fusion for multilevel lumbar spinal stenosis associated with degenerative scoliosis were reviewed retrospectively. OBJECTIVES: To assess the effectiveness of the cage-instrumented posterior lumbar interbody fusion in multilevel lumbar spinal stenosis associated with degenerative scoliosis. SUMMARY OF LITERATURE REVIEW: Degenerative lumbar scoliosis with the problems of neurogenic claudication, mechanical back pain and spinal deformity present a challenge for treatment. MATERIALS AND METHODS: We reviewed 18 surgical cases of multilevel lumbar spinal stenosis with degenerative scoliosis from March 1995 to April 2000 with an average follow up period of 2.9 years. We assessed the radiographic results of scoliotic angle correction and sagittal angle correction of the maximum curve and fused segment and disc height restoration. Clinical results were evaluated according to the Kirkaldy-Willis criteria. RESULTS: Mean scoliotic angle at preoperative, postoperative and final follow-up (maximum curve/fused segment) was 17.7-6.1-7.3degree /15.0-5.8-6.1degree respectively. Mean sagittal angle corresponding to each period was 12.1-34.1-32.7degree /8.3-27.0-26.0degree respectively. Mean disc height corresponding to each period was 22.9-42.4-40.5% respectively. The clinical result was analyzed as 15 satisfactory (83.3%), 3 fair (16.7%) and no poor. Fusion success was achieved in all patients. There were no serious complications except one case of fusion extension distally and no significant curve progression within follow-up period. CONCLUSIONS: The cage-posterior lumbar interbody fusion in multilevel lumbar spinal stenosis with degenerative scoliosis was effective for correction of scoliotic and sagittal deformity and restoration of disc height with resultant foraminal patency, provided relatively high clinical success and in situ fusion success in all cases even over multiple fusion levels, and can be an alternative among surgical treatments of this complex disease.

Correction of Curve and Determination of Fixation Segment in Degenerative Lumbar Scoliosis / 대한척추외과학회지

STUDY DESIGN: This retrospective study was designed to investigate the effectiveness of surgical procedure for degenerative lumbar scoliosis. OBJECTIVES: To evaluate surgical outcome on symptomatic degenerative lumbar scoliosis and to analyze the cause of decompensation of the curve at the above segment adjacent to fused vertebra. SUMMARY OF LITERATURE REVIEW: Few studies evaluated the surgical outcome of patients with symptomatic degenerative lumbar scoliosis, and observed the postoperative deompensation of the curve at adjacent segment. MATERIALS AND METHODS: Thirty patients were retrospectively reviewed. All patients underwent decompressive laminectomy, transpedicular screw fixation, and intertransverse fusion by autogenous bone graft. Scoliotic angle within curves and within fused segments were measured by Cobb's method. Changes of the adjacent segment were analyzed. RESULTS: The overall satisfactory clinical results was noted in 25(83%) of 30 patients. The curve preoperative averaged 13.3 degrees +/- 4.0 degrees, 5.5 degrees +/-3.2 degrees after surgery and curves at final follow-up 8.6 degrees +/-6.2 degrees. In six patients(20%) decompensation of the curve with more than 5degrees occurred at the adjacent segment above to the fused segments. This decompensation of the curve closely correlated to the lateral translation at adjacent segments and postoperative pain. Sagittal profile was not significantly improved following surgery. CONCLUSIONS: Uncorrected lateral translation at the unfused adjacent segment resulted in progression of the coronal deformity at upper adjacent segment to fused vertebrae. Therefore, in fusion operation upper end vertebra with lateral instability should be included to prevent the postoperative decompensation.

Surgical Management of Spinal Stenosis with Degenerative Lumbar Scoliosis / 대한정형외과학회잡지

The coexistence of spinal stenosis and scoliosis in lumbar spines is becoming a more frequent problem in elderly persons. Decreased bone mass in most of these patients also complicates their management. Recently, the pedicle screw instrumentation systems offer the way to solve these difficult problems. Most of the cases with degenerative scoliosis itself don't require surgical intervention. However, the case with severe clinical manifestations need surgery. From Jan. 1988 to Oct. 1993, authors had treated operatively for 15 cases of spinal stenosis with degenerative lumbar scoliosis. After adequate posterior decompression, pedicular instrumentation was carried out and correction of scoliotic deformity was attempted. Cotrel-Dubousset instrumentation was used in six patients, Graf instrumentation in three patients, and combined(Steffee and Graf) instrumentation in six patients. Follow up was obtained at an average of 20.4 months(Range; 10