Degenerative lumbar scoliosis in elderly patients: dynamic stabilization without fusion versus posterior instrumented fusion |
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| Authors: | Mario Di Silvestre Francesco Lolli Georgios Bakaloudis |
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| Affiliation: | 1. ORA Orthopedics, 520 Valley View Drive #100, Moline, IL 61265, USA;2. Orthopaedic and Sports Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359798, Seattle, WA 98104-2499, USA;1. Department of Orthopaedics and Sports Medicine, University of South Florida, 13220 USF Laurel Dr, Tampa, FL 33612, USA;2. Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA;3. Center for Spinal Disorders, Florida Orthopaedic Institute, 13020 N. Telecom Parkway, Tampa, FL 33637, USA;1. Clinica Ortopedica, University of Genoa, IRCCS A.O.U. San Martino – Ist, Genova, Largo R. Benzi 10, 16100, Italy;2. Ortopedia e Traumatologia d''urgenza, IRCCS A.O.U. San Martino – Ist, Genova, Largo R. Benzi 10, 16100, Italy;1. Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti South Road, Chaoyang District Beijing 100020, China;2. Department of Orthopedic Surgery, Shenzhou Hospital, Shenyang Medical College, 20 North nine Road, Heping District Shenyang 110002, China;3. Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti South Road, Chaoyang District Beijing 100020, China;1. Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1419733141, Iran;2. Brain and Spinal Cord Injuries Repair Research Center, Imam Khomeini Hospital, Tehran 1419733141, Iran;3. Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1419733141, Iran;1. Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 3021, Kansas City, KS 66160, USA;2. Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada;3. Toronto Western Hospital, 399 Bathurst St, #4W-449, Toronto, ON, Canada;4. Department of Health Services, University of Washington, Box 359455, 4333 Brooklyn Ave NE, Rm 14-315, Seattle, WA 98195-9455, USA;5. Department of Orthopaedic Surgery, Emory University, Emory Orthopaedics & Spine Center, 59 Executive Park South, Atlanta, GA 30329, USA;6. Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107-4216, USA;7. Department of Orthopaedics, University of Utah, University Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA;8. Department of Neurological Surgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA 22908-0212, USA;9. Department of Orthopedic Surgery, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA;10. Boston Spine Group, 299 Washington St, Newton, MA 02458, USA;11. Department of Orthopaedics, University of Washington, Orthopaedic Trauma Surgery Clinic at Harborview, Harborview Medical Center, 1 West Clinic, Box 359798, 325 Ninth Ave, Seattle, WA 98104, USA;12. Spine Education and Research Institute, Center for Spinal Disorders, 9005 Grant St., Suite 200, Thornton, CO 80229, USA;13. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, 75 Francis St., Boston, MA 02115, USA;14. Department of Orthopedic Surgery, Indiana Spine Group, 8040 Clearvista Parkway, Suite 450, Indianapolis, IN 46256, USA;15. The CORE Institute, Center for Orthopedic Research and Education, 3010 W. Agua Fria Fwy #100, Phoenix, AZ 85027, USA;p. Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 7-109, 600 North Wolfe St., Baltimore, MD 21287, USA |
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| Abstract: | ![]()
Background contextPosterolateral fusion with pedicle screw instrumentation is currently the most widely accepted technique for degenerative lumbar scoliosis in elderly patients. However, a high incidence of complications has been reported in most series. Dynamic stabilization without fusion in patients older than 60 years has not previously been compared with the use of posterior fusion in degenerative lumbar scoliosis.PurposeTo compare dynamic stabilization without fusion and posterior instrumented fusion in the treatment of degenerative lumbar scoliosis in elderly patients, in terms of perioperative findings, clinical outcomes, and adverse events.Study designA retrospective study.Patient sampleFifty-seven elderly patients were included. There were 45 women (78%) and 12 men (22%) with a mean age of 68.1 years (range, 61–78 years). All patients had degenerative de novo lumbar scoliosis, associated with vertebral canal stenosis in 51 cases (89.4%) and degenerative spondylolisthesis in 24 patients (42.1%).Outcome measuresClinical (Oswestry Disability Index, visual analog scale, Roland-Morris Disability Questionnaire) and radiological (scoliosis and lordosis corrections) outcomes as well as incidence of complications.MethodsPatients were divided into two groups: 32 patients (dynamic group) had dynamic stabilization without fusion and 25 patients (fusion group) underwent posterior instrumented fusion. All the patients' medical records and X-rays were reviewed. Preoperative, postoperative, and follow-up questionnaires were obtained to evaluate clinical outcomes.ResultsAt an average follow-up of 64 months (range, 42–90 months), clinical results improved similarly in both groups of patients. Statistically superior scoliosis and final lordosis corrections were achieved with posterior fusion (56.9% vs. 37.3% and ?46.8° vs. ?35.8°, respectively). However, in the dynamic group, incidence of overall complications was lower (25% vs. 44%), and fewer patients required revision surgery (6.2% vs. 16%). Furthermore, lower average values of operative duration (190 vs. 240 minutes) and blood loss (950 vs. 1,400 cc) were observed in the dynamic group than in the fusion group.ConclusionsIn elderly patients with degenerative lumbar scoliosis, pedicle screw–based dynamic stabilization was less invasive with shorter operative duration, less blood loss, and lower adverse event rates than instrumented posterior fusion. Scoliosis curve reduction and lumbar lordosis were superior after fusion; however, dynamic stabilization achieved satisfying values of both these parameters, and these results were stable after an average follow-up of more than 5 years. Furthermore, there was no difference between the two techniques in terms of functional clinical outcomes at the last follow-up. |
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