Surgical treatment of degenerative scoliosis in adults using a posterior approach. Case Series

Abstract

Background: Degenerative scoliosis is a deformity of the spine with curvatures > 10º. Prevalence is 1-10%, in patients over 50 years-old. It is associated with asymmetric disc degenerations and facet deformities. The posterior instrumentation arthrodesis (PIA) offers advantages superior to the surgical approaches that combine previous and posterior techniques. Transpedicular arthrodesis allows the correction of deformities, posterior decompression of the neural elements, and better pulmonary tolerance in a single surgical time.
Materials and methods: A review was made of the medical records of patients that underwent PIA for degenerative deformities, were older than 50 years of age, and with failure in conservative treatment. Pre-operative symptoms, trans- and post-operative complications, pain control and return to activities were documented.
Results: Of the 23 patients obtained between January 2012 and January 2015, 12 were males, and the mean age was 65.82 years. A history of discitis was found in 4 of them. All had axial and radicular pain, with 73.91% neurogenic claudication. The complications included: 3 dural tears without fistula, 2 flat asymptomatic shoulders, and 2 ISO. The success rate was 86.95%, with adequate pain control and return to previous activities. The revision rate was 0%
Discussion: PIA can be used safely and effectively as an alternative in degenerative scoliosis, with adequate pain control and return to previous activities. A pattern has recently been established that replaces combined or anterior approaches only with circumferential arthrodesis techniques effective from a lateral approach, with less bleeding, less surgical time, better maintenance of the correction, and fewer complications.
Evidence level: IV