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