Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.

ABSTRACT

Spinal stenosis in combination with scoliosis frequently is seen in elderly patients. Patients typically present with a combination of symptoms attributable to neurogenic claudication and radicular pain, and symptoms of lower back pain. For patients in whom conservative treatment is not sufficient, surgical treatment can be done with careful consideration of the overall patient and his or her medical status. Surgical treatment is twofold; one purpose is to decompress the neural elements, the other purpose is to stabilize and realign the spine to as great a degree as possible. Appropriate balance of the spine at the end of the procedure is more important than the absolute amount of correction obtained. Stabilization and correction of the spine is done with pedicle screw-rod instrumentation and fusion, and the procedure must be done in an efficient and timely manner to involve the least amount of morbidity. There are two types of deformity typically seen, one is a degenerative lumbar scoliosis with no or minimal rotational deformity (Type I), and the other is a degenerative scoliosis often superimposed on a preexisting scoliosis with greater rotational deformity and greater loss of lordosis (Type II). Instrumentation and correction techniques differ for these two types of deformities, with shorter instrumentation procedures usually possible for the Type I deformity and longer instrumentation with sagittal plane reconstitution necessary for Type II deformity.