Treatment of kyphotic deformities in adults: our experience.

PURPOSE: Many degenerative phenomena frequently result into kyphotic lumbar and thoracic deformities or cause their progression combined with deformities on the frontal plane of the spine. In these patients, the progression of the sagittal imbalance may lead to a series of disabling functional and painful consequences. The analysis of the spinopelvic parameters biases the choice of the correction surgical strategy aimed at restoring a good tri-dimensional and sagittal balance of the spine. MATERIALS AND METHODS: Sample included 62 patients treated in our Operation Unit that were enrolled for evaluation; they were affected with prevailing sagittal deformities. RESULTS: Clinical results were evaluated through the administration of SF-36, Oswestry Disability Index (ODI), Roland Morris (RM), and visual analogical scale (VAS). CONCLUSIONS: In our experience, patients with sagittal imbalance and short fusion areas show a higher risk of correction loss; the arthrodesis area must include the thoracolumbar junction, and it is often necessary to include the whole thoracic spine in the arthrodesis area. This is to avoid any loss of correction, implants mobilization, and proximal hyperkyphosis.

The surgical treatment of adult lumbar scoliosis.

Between January 1990 and December 1999 a total of adults (49 females and 16 males) aged from 37 to 72 years (mean age 54 +/- 3) underwent surgery and were followed up minimum of 2 year after treatment for symptomatic adult lumbar scoliosis. As for features of the clinical symptoms, the cases were divided into four groups, characterized by symptoms that gradually increased in importance and in frequency, the type of deformity and degree of deviation (scoliosis and lumbar kyphosis are reported). Adult and elderly lumbar spine deformities are often symptomatic, because the degenerative changes of deformed spine and the progression of the deformity. Patients with such a clinical picture need surgical correction of the deformity in order to improve their symptoms. Sometimes these patients undergo disc herniation surgical procedures, because of wrong interpretations of CT scans or MR images. Segmental instrumentation correction devices led to a fair correction of deformities, and improvement of back and radiated pain. Despite the great improvements (both in instrumentation devices and anesthesiological techniques) this surgery remain a major surgery, both of (or) the patient and the surgeon.