Surgical Strategy in Adult Lumbar Scoliosis: The Utility of Categorization Into 2 Groups Based on Primary Symptom, Each With 2-Year Minimum Follow-up


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Abstract

Study Design.This is a cohort investigation of 2 categories of patients with adult lumbar scoliosis.Objective.To demonstrate the different surgical strategies between 2 categories of patients with adult lumbar scoliosis based on their symptoms and radiological findings.Summary of Background Data.It has been hypothesized that patients with adult lumbar scoliosis should be categorized, when possible, into 2 distinct groups on the basis of clinical symptoms and that this categorization can best guide surgical treatment strategy.Methods.Between January 2002 and December 2004, 43 patients with adult lumbar scoliosis underwent surgical treatment. Each patient was categorized into 1 of 2 distinct groups before surgery. Group 1 patients had primary symptoms related to stenosis, and the surgical strategy was posterior local decompression with or without instrumented fusion at the treated levels. Group 2 patients had primary symptoms related to symptomatic or progressive deformity, and the surgical strategy was instrumented fusion, to include at least the end vertebrae, by posterior or by combined anterior/posterior approach, with or without selective decompression. Preoperative and postoperative radiographical evaluation was performed. Preoperative and postoperative clinical outcomes utilized were the Modified Prolo Scale and the Patient Satisfaction Index (PSI).Results.The average age at the time of treatment was 61 years. The mean follow-up time after surgery was 35 months (range, 24–65 months). A radiographical grade I fusion (definitely fused) was achieved in 65% of cases. Failure of fusion was seen in 9.1% for group 1 and 9.5% for group 2. In group 1, the average Modified Prolo Scale was 9.5 before surgery and 15.9 at follow-up and total satisfaction rate (PSI) was 82%. In group 2, the average Modified Prolo Scale was 10.9 before surgery and 17.0 at follow-up and total satisfaction rate (PSI) was 86%.Conclusion.Categorization of patients into 2 groups, 1 with primarily stenosis symptoms and 1 with primarily deformity symptoms, may be effective for surgical decision making. These 2 categories of patients may be expected to enjoy similar clinical improvements after surgical treatment.

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