Abstract
Degenerative lumbar scoliosis with lateral deviation of the spine is frequently seen in elderly. Clinical presentation varies. The deformity is often associated with loss of lordosis, axial rotation and spinal stenosis. The operative treatment is a challenge to achieve the greatest benefit with least amount of intervention. Therefore the potential benefit to be obtainened by means of spinal fusion must be measured against the operative risks. A retrospective study was performed to investigate patient outcomes after fusion for degenerative lumbar scoliosis using XIA-Instrumentation. Functional outcome was assessed 2 to 9 years later using the Roland Morris score, a visual analogue scale and the Short Form 36 Health survey. The aim was to determine the effectiveness of the surgical procedure in terms of patient satisfaction, outcome scores and radiological aspects. There is an accepted deficiency of this form of outcomes assessment in the literature
Methods: Final evaluation was possible in 28 patients at a mean period of observation of 48 months. Inclusion criteria were: age ≥60 years, Cobb angle preop. greater than 15degrees, degenerative deformity, no prior surgery (spine), and complete records. Each patient completed the standard Short Form-36 (SF-36) questionnaire. Radiographic and clinical data were evaluated. The measures of outcomes assessment included patient satisfaction, pain scores, low back outcome, medication use and social status.
Results: Questionnaire data indicated good satisfactory and bad surgical results in 9 (32%), 12 (43%) and 7 (25%) patient. Scoliosis was converted from a mean preoperative Cobb angle of 17 degrees to 10 degrees. On an average of 5 spinal segments were instrumented and fused. In the first two years after spinal fusion the patient satisfaction was about 90%. In the following years until final evaluation the satisfaction rate decrease continuously by all patients often caused by adjacent instability of neighbouring unfixed motion segments. No pseudarthrosis were seen in final evaluation.
Conclusion: Proper preoperative planning, a sufficient fusion length and a good biomechanical properties of the used implants, such as XIA, are prior to prevent adjacent instability and can achieve satisfactory results with less operative risks.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
