SURGICAL TREATMENT OF DEGENERATIVE LUMBAR SCOLIOSIS WITH MULTI-SEGMENT LUMBAR SPINAL STENOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LANJiaping ^1,2 ,  TANGXun ¹ , XUYongqing ¹ , ZHOUTianhua ¹ , SHIJian ¹ , CUIYi ¹ , XIANGQili ¹ , CAIZhijun ^1,2 , ZHAOQingkai ^1,3 , YANGXiaoyong ^1,3 , ZHAOCaihua ^1,2

1. Affiliated Orthopedic Hospital, Trauma Orthopedic Institute of Chinese PLA, Kunming General Hospital of Chengdu Military Command of Chinese PLA, Kunming Yunnan, 650032, P. R. China;
2. Kunming General Hospital Clinical College of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;
3. Kunming General Hospital Clinical College of the 3rd Military Medical University of Chinese PLA;

Corresponding author：

TANGXun, Email: tangxun657@126.com

Keywords：

Degenerative lumbar scoliosis; Multi-segment lumbar spinal stenosis; Posterior approach; Multi-segment decompression; Fusion

DOI：

10.7507/1002-1892.20140211

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Objective To explore the surgical indications,decompression and fusion method,and fusion level selection of degenerative lumbar scoliosis (DLS) and multi-segment lumbar spinal stenosis. Methods Between April 2000 and November 2011,46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion (5 segments or above).Of 46 cases,25 were male and 21 were female,with a mean age of 70.2 years (range,65-81 years) and with a mean disease duration of 6.4 years (range,4 years and 6 months to 13 years).X-ray films showed that the lumbar Cobb angle was (26.7±10.0)°,and the lumbar lordotic angle was (20.3±8.8)°.The lumbar CT and MRI images showed three-segment stenosis in 24 cases,four-segment stenosis in 17 cases,and five-segment stenosis in 5 cases.A total of 165 stenosed segments included 12 L_1,2,34 L_2,3,43 L_3,4,45 L_4,5,and 31 L₅ and S₁.Visual analogue scale (VAS) score,Oswestry disability index (ODI),and Japanese Orthopedic Association (JOA) score (29 points) were employed to evaluate effectiveness. Results Thirteen patients had leakage of cerebrospinal fluid during operation,and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively,who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change,adequate drainage,debridement and suture.No death,paralysis,central nervous system infection,or other complication was observed in these patients.Forty-six cases were followed up 12-72 months (mean,36.2 months).Lumbago and backache and intermittent claudication of lower extremity were obviously improved.During follow-up,no screw incising,loosening and broken screws,or pseudarthrosis was noted under X-ray film and CT scanning.At last follow-up,the lumbar Cobb angle was reduced to (9.8±3.6)°,while the lumbar lordotic angle was increased to (34.1±9.4)°,which were significantly improved when compared with preoperative ones (t=16.935,P=0.000;t=15.233,P=0.000).At last follow-up,VAS,ODI,and JOA scores were 3.2±1.2,35.5%±14.0%,and 26.6±5.7 respectively,showing significant differences when compared with preoperative scores (8.0±2.2,60.8%±13.3%,and 12.9±3.4) (t=19.857,P=0.000;t=16.642,P=0.000;t=15.922,P=0.000). Conclusion Multi-segment decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion is helpful to relieve nerve compression symptoms,rebuild spinal balance,and improve the life quality of the patients.It is a very effective way to treat DLS and multi-segment lumbar spinal stenosis.

Citation： LANJiaping, TANGXun, XUYongqing, ZHOUTianhua, SHIJian, CUIYi, XIANGQili, CAIZhijun, ZHAOQingkai, YANGXiaoyong, ZHAOCaihua. SURGICAL TREATMENT OF DEGENERATIVE LUMBAR SCOLIOSIS WITH MULTI-SEGMENT LUMBAR SPINAL STENOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 960-964. doi: 10.7507/1002-1892.20140211 Copy

1.	Fraser JF,Huang RC,Girardi FP,et al.Pathogenesis,presentation,and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities.Neurosurosurg Focus,2003,14(1):e6.
2.	Schwab FJ,Smith VA,Biserni M,et al.Adult scoliosis:a quantitative radiographic and clinical analysis.Spine (Phila Pa 1976),2002,27(4):387-392.
3.	Tambe AD,Michael ALR.Adult degenerative scoliosis.J Orthop Trauma,2011,25(6):413-424.
4.	Grubb SA,Lipscomb HJ,Suh PB.Results of surgical treatment of painful adult scoliosis.Spine (Phila Pa 1976),1994,19(14):1619-1627.
5.	de Vries AA,Mullender MG,Pluymakers WJ,et al.Spinal decompensation in degenerative lumbar scoliosis.Eur Spine J,2010,19(9):1540-1544.
6.	Hosogane N,Watanabe K,Kono H,et al.Curveprogression after decompression surgery in patients with mild degenerative scoliosis.J Neurosurg Spine,2013,18(4):321-326.
7.	张志成,任大江,孙天胜,等.退变性腰椎侧凸合并腰椎管狭窄的阶梯性治疗策略.中国修复重建外科杂志,2011,25(8):951-955.
8.	Gupta MC.Degenerative scoliosis.Options for surgical management.Orthop Clin North Am,2003,34(2):269-279.
9.	Li F,Chen Q,Chen W,et al.Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis.J Spinal Disord Tech,2011,24(5):308-312.
10.	Sansur CA,Smith JS,Coe JD,et al.Scoliosis research society morbidity and mortality of adult scoliosis surgery.Spine (Phila Pa 1976),2011,36(9):E593-597.
11.	赵庆华,田纪伟,王雷,等.老年人腰椎退变性侧凸症手术治疗的临床分析.中国矫形外科杂志,2009,17(15):1121-1123.
12.	Houten JK,Nasser R.Symptomatic progression of degenerative scoliosis after decompression and limited fusion surgery for lumbar spinal stenosis.J Clin Neurosci,2013,20(4):613-615.
13.	卢旭华,陈德玉,袁文,等.腰椎退变性侧凸的治疗策略.脊柱外科杂志,2008,6(1):8-11.
14.	Murata Y,Takahashi K,Hanaoka E,et al.Changes in scoliotic curvature and lordoticangle during the early phase of degenerative lumbar scoliosis.Spine (Phila Pa 1976),2002,27(20):2268-2273.
15.	Ploumis A,Christodiulou P,Kapoutsis D,et al.Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion.A case series.J Orthop Surg Res,2012,7:35.
16.	Son S,Kim WK,Lee SG,et al.A comparison of the clinical outcomes of decompression alone and fusion in elderly patients with two-level or more lumbar spinal stenosis.J Korean Neurosurg Soc,2013,53(1):19-25.
17.	Wu CH,Wong CB,Chen LH,et al.Instrumented posterior lumbar interbody fusion for patients with degenerative lumbar scoliosis.J Spinal Disord Tech,2008,21(5):310-315.
18.	Yasuhara T,Takahashi Y,Kumamoto S,et al.Proximal vertebral body fracture after 4-level fusion using l1 as the upper instrumented vertebra for lumbar degenerative disease:report of 2 cases with literature review.Acta Med Okayama,2013,67(3):197-202.
19.	Cho KJ,Suk SI,Park SR,et al.Selection of proximal fusion level for adult degenerative lumbar scoliosis.Eur Spine J,2013,22(2):394-401.
20.	Cho KJ,Suk SI,Park SR,et al.Short fusion versus long fusion for degenerative lumbar scoliosis.Eur Spine J,2008,17(5):650-656.

1. Fraser JF,Huang RC,Girardi FP,et al.Pathogenesis,presentation,and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities.Neurosurosurg Focus,2003,14(1):e6.
2. Schwab FJ,Smith VA,Biserni M,et al.Adult scoliosis:a quantitative radiographic and clinical analysis.Spine (Phila Pa 1976),2002,27(4):387-392.
3. Tambe AD,Michael ALR.Adult degenerative scoliosis.J Orthop Trauma,2011,25(6):413-424.
4. Grubb SA,Lipscomb HJ,Suh PB.Results of surgical treatment of painful adult scoliosis.Spine (Phila Pa 1976),1994,19(14):1619-1627.
5. de Vries AA,Mullender MG,Pluymakers WJ,et al.Spinal decompensation in degenerative lumbar scoliosis.Eur Spine J,2010,19(9):1540-1544.
6. Hosogane N,Watanabe K,Kono H,et al.Curveprogression after decompression surgery in patients with mild degenerative scoliosis.J Neurosurg Spine,2013,18(4):321-326.
7. 张志成,任大江,孙天胜,等.退变性腰椎侧凸合并腰椎管狭窄的阶梯性治疗策略.中国修复重建外科杂志,2011,25(8):951-955.
8. Gupta MC.Degenerative scoliosis.Options for surgical management.Orthop Clin North Am,2003,34(2):269-279.
9. Li F,Chen Q,Chen W,et al.Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis.J Spinal Disord Tech,2011,24(5):308-312.
10. Sansur CA,Smith JS,Coe JD,et al.Scoliosis research society morbidity and mortality of adult scoliosis surgery.Spine (Phila Pa 1976),2011,36(9):E593-597.
11. 赵庆华,田纪伟,王雷,等.老年人腰椎退变性侧凸症手术治疗的临床分析.中国矫形外科杂志,2009,17(15):1121-1123.
12. Houten JK,Nasser R.Symptomatic progression of degenerative scoliosis after decompression and limited fusion surgery for lumbar spinal stenosis.J Clin Neurosci,2013,20(4):613-615.
13. 卢旭华,陈德玉,袁文,等.腰椎退变性侧凸的治疗策略.脊柱外科杂志,2008,6(1):8-11.
14. Murata Y,Takahashi K,Hanaoka E,et al.Changes in scoliotic curvature and lordoticangle during the early phase of degenerative lumbar scoliosis.Spine (Phila Pa 1976),2002,27(20):2268-2273.
15. Ploumis A,Christodiulou P,Kapoutsis D,et al.Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion.A case series.J Orthop Surg Res,2012,7:35.
16. Son S,Kim WK,Lee SG,et al.A comparison of the clinical outcomes of decompression alone and fusion in elderly patients with two-level or more lumbar spinal stenosis.J Korean Neurosurg Soc,2013,53(1):19-25.
17. Wu CH,Wong CB,Chen LH,et al.Instrumented posterior lumbar interbody fusion for patients with degenerative lumbar scoliosis.J Spinal Disord Tech,2008,21(5):310-315.
18. Yasuhara T,Takahashi Y,Kumamoto S,et al.Proximal vertebral body fracture after 4-level fusion using l1 as the upper instrumented vertebra for lumbar degenerative disease:report of 2 cases with literature review.Acta Med Okayama,2013,67(3):197-202.
19. Cho KJ,Suk SI,Park SR,et al.Selection of proximal fusion level for adult degenerative lumbar scoliosis.Eur Spine J,2013,22(2):394-401.
20. Cho KJ,Suk SI,Park SR,et al.Short fusion versus long fusion for degenerative lumbar scoliosis.Eur Spine J,2008,17(5):650-656.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL TREATMENT OF DEGENERATIVE LUMBAR SCOLIOSIS WITH MULTI-SEGMENT LUMBAR SPINAL STENOSIS

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