Document Detail


Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy.
MedLine Citation:
PMID:  20802398     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: A retrospective clinical cohort study at a single spine center of patients with degenerative scoliosis and radiculopathy severe enough to require surgery.
OBJECTIVE: To evaluate the functional outcomes of 3 surgeries for degenerative scoliosis with radiculopathy; decompression alone, decompression and limited fusion, and decompression and full curve fusion.
SUMMARY OF BACKGROUND DATA: Although these 3 surgical treatments have all been described for this problem, there exists little information as to what outcomes to expect.
METHODS: The study cohort consisted of 85 patients who met the inclusion criteria of degenerative scoliosis and radiculopathy, who had undergone 1 of the above 3 surgeries, who had not had any previous lumbar spine surgery, who had a minimum follow-up of at least 2 years, and who had filled out preoperative and postoperative functional evaluation forms including SF-36, Oswestry Disability Index, Roland Morris Scores, and a satisfaction questionnaire. Logistic regression analysis was conducted to predict the likelihood of success as related to decompression alone of rotatory olisthetic segments, extent of fusion, and postoperative sagittal balance. Patient demographics including curve magnitude, operative blood loss, length of hospital stay, complications, and need for revision surgeries were analyzed. The patients having decompression alone had the highest mean age (76.4 years) compared to decompression and limited fusion (70.4), and decompression and full curve fusion (62.5).
RESULTS: Cobb scoliosis angles remained unchanged in the 2 groups not having full curve fusion, while the full curve fusion group changed from a mean 39° before surgery to 19° at follow-up. The complication rate was highest (56%) in the full fusion group, was 40% in the limited fusion group, and 10% in the decompression alone group. The overall SF-36 analysis showed significant improvement in bodily pain, social function, role emotional, mental health, and mental composite domains. Oswestry Disability Indexes improved significantly in the decompression alone and limited fusion groups, but not in the full fusion group. In contrast, the satisfaction questionnaire showed the highest success to be in the full-curve fusion group and the lowest in the decompression-only group.Regression analysis revealed that sacrum to curve apex fusions and positive postoperative sagittal imbalance were associated with poor outcomes.
CONCLUSION: Both good and poor results were seen with each of the 3 procedures.
Authors:
Ensor E Transfeldt; Raymond Topp; Amir A Mehbod; Robert B Winter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  35     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-17     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1872-5     Citation Subset:  IM    
Affiliation:
Twin Cities Spine Center, Minneapolis, MN, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cohort Studies
Comorbidity
Decompression, Surgical / methods*
Disability Evaluation
Follow-Up Studies
Humans
Middle Aged
Patient Satisfaction
Radiculopathy / epidemiology,  surgery*
Regression Analysis
Retrospective Studies
Scoliosis / epidemiology,  surgery*
Spinal Fusion / methods*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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