Comparison of surgical and conservative treatment for degenerative lumbar scoliosis.

INTRODUCTION: Demographic changes create an expansion of the elderly population segment of society. Demands of mobility and quality of life have increased in this age group over the last decades. A rising number of elderly patients suffering from degenerative "de novo" lumbar scoliosis (DLS) may be eligible for surgical options to treat their spinal deformities. Therefore, we compared the clinical and radiographic results of conservative and surgical treatment. MATERIALS AND METHODS: During 1990-2003, 55 patients with DLS were treated and followed up for a minimum of 24 months. Group 1 patients (n=26) underwent surgery (decompression and spondylodesis), group 2 patients (n=29) declined surgery and received conservative treatment (analgesics, physiotherapy). Clinical data, theatre records and X-rays were analysed. All patients were contacted and 73.1% of group 1 and 75.8% of group 2 patients were clinically re-evaluated and received standing radiographs on average 4.8 and 3.8 years after the initial procedure or consultation, respectively. RESULTS: We found a significantly higher rate of spinal stenosis and degenerative spondylolisthesis in group 1 patients (P<0.01). The procedure corrected the lumbar deformity in the frontal and sagittal planes. Three patients required revision for implant failure. Walking distance improved significantly during the postoperative course. Analgesic requirement decreased in comparison to group 2 patients. No significant difference was evident between the groups in terms of lumbar back pain after 3.8 and 4.8 years, respectively. CONCLUSION: Operative treatment of DLS with decompression in combination with a longer fusion improved walking ability and quality of life. Reduced need of analgesics can be anticipated. Benefits of surgery and risks of complications have to be considered carefully to avoid disappointment in expectations.

Distractible vertebral body replacement in patients with malignant vertebral destruction or osteoporotic burst fractures.

We studied prospectively the clinical and radiological course of 36 patients with localised spinal instability treated with vertebrectomy. A distractible titanium cage filled with polymethylmethacrylate(PMMA) in combination with transpedicular fixation was used to restore spinal stability. Mean follow-up was 16 (8-55) months. Average correction of the segmental kyphosis was 15.2 degrees (-2-29 degrees). During follow-up, a loss of correction of 0.9 degrees (-2-15 degrees) was seen. Segmental height was increased by 7.6 (0-14) mm on average with a mean loss of 1.6 (0-2) mm. Twenty-one patients without pre-operative neurological deficits were ambulatory without orthosis at discharge. Patients presenting with neurological deficits were unchanged (n=3) or improved (n=12).