Safdar Khan, MD Safdar Khan, MD -- OrthopedicsOrthopedics
H. Francis Farhadi, MD, PhDH. Francis Farhadi, MD, PhD -- NeurosurgeryNeurosurgery
68 yro F with leg > back pain
Worse on the right and with standing/walking
ODI 54% Failed PT and
injection trials
Scoliosis + Spondylolisthesis
Unstable lateral spondylolisthesis at L2-L3
Stable anterior spondylolisthesis at L4-L5
1 yr post-op
VAS back and leg 0/10
ODI 20%
Deformity in Coronal and Sagittal Planes
Incidence: 2.5-15% Degenerative changes in the intervertebral discs, facets, and osteoporosis Associated with spondylolisthesis, lateral subluxation, and sagittal imbalance Clinical presentation: LBP, neurogenic claudication, radiculopathy, flat-back syndrome Treatment
Conservative: NSAIDs, analgesics, PT, brace, injectionsSurgery
Degenerative Scoliosis
Surgical Indications Failure of conservative
treatment Significant and progressive
spinal deformity Functionally disabling
neurological deficits
Surgical Techniques Decompression alone Decompression plus fusion
(extent of fusion, correction of deformity, posterior vs. anterior/posterior)
Degenerative Scoliosis
Degenerative scoliosis presents with varying degrees of curve magnitudes and stenosis Pritzell, Simmons,
Dawson, Schwab, etc Ploumis et al, 2008 (mild
Grade I, moderate with lateral listhesis Grade II, and severe with global imbalance Grade III)
Individualized treatment in terms of levels of fusion, extent of instrumentation, anterior/posterior approaches.
Pitfalls (Patient Evaluation)
Clinical symptoms are more important than imaging findings
Distinguish deformity vs. degenerative
Assess both primary and fractional or compensatory curvature
Assess sagittal alignment but distinguish flat-back deformity from lumbar stenosis presenting as sagittal imbalance
Conclusions
Degenerative scoliosis presents with varying degrees of curve magnitudes and stenosis
Individualized treatment in terms of levels of fusion, extent of instrumentation, anterior/posterior approaches. Decompression only Laminectomy plus fusion with or
without instrumentation A/P and/or osteotomy for curve
correction for global imbalance
Newer techniques XLIF and minimally invasive posterior
decompression and fusion Motion preservation (ie, TDR, etc)
Discussion and Questions