Safdar Khan, MD - - Orthopedics Orthopedics Safdar Khan, MD H. - PowerPoint PPT Presentation

Safdar Khan, MD - - Orthopedics Orthopedics Safdar Khan, MD H. Francis Farhadi, MD, PhD - - Neurosurgery Neurosurgery H. Francis Farhadi, MD, PhD

 68 yro F with leg > back pain  Worse on the right and with standing/walking  ODI 54%  Failed PT and injection trials  Scoliosis + Spondylolisthesis

 Unstable lateral spondylolisthesis at L2-L3  Stable anterior spondylolisthesis at L4-L5

 1 yr post-op  VAS back and leg 0/10  ODI 20%

Deformity in Coronal and Sagittal Planes  Incidence: 2.5-15%  Degenerative changes in the intervertebral discs, facets, and osteoporosis  Associated with spondylolisthesis, lateral subluxation, and sagittal imbalance  Clinical presentation: LBP, neurogenic claudication, radiculopathy, flat-back syndrome  Treatment  Conservative: NSAIDs, analgesics, PT, brace, injections  Surgery

Degenerative Scoliosis  Surgical Indications  Failure of conservative treatment  Significant and progressive spinal deformity  Functionally disabling neurological deficits  Surgical Techniques  Decompression alone  Decompression plus fusion (extent of fusion, correction of deformity, posterior vs. anterior/posterior)

Degenerative Scoliosis  Degenerative scoliosis presents with varying degrees of curve magnitudes and stenosis  Pritzell, Simmons, Dawson, Schwab, etc  Ploumis et al, 2008 (mild Grade I, moderate with lateral listhesis Grade II, and severe with global imbalance Grade III)  Individualized treatment in terms of levels of fusion, extent of instrumentation, anterior/posterior approaches.

Pitfalls (Patient Evaluation)  Clinical symptoms are more important than imaging findings  Distinguish deformity vs. degenerative  Assess both primary and fractional or compensatory curvature  Assess sagittal alignment but distinguish flat-back deformity from lumbar stenosis presenting as sagittal imbalance

Conclusions  Degenerative scoliosis presents with varying degrees of curve magnitudes and stenosis  Individualized treatment in terms of levels of fusion, extent of instrumentation, anterior/posterior approaches.  Decompression only  Laminectomy plus fusion with or without instrumentation  A/P and/or osteotomy for curve correction for global imbalance  Newer techniques  XLIF and minimally invasive posterior decompression and fusion  Motion preservation (ie, TDR, etc)

Discussion and Questions