%0 Journal Article
%T Adult's Degenerative Scoliosis: Midterm Results of Dynamic Stabilization without Fusion in Elderly Patients¡ªIs It Effective?
%A Mario Di Silvestre
%A Francesco Lolli
%A Tiziana Greggi
%A Francesco Vommaro
%A Andrea Baioni
%J Advances in Orthopedics
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/365059
%X Study Design. A retrospective study. Purpose. Posterolateral fusion with pedicle screw instrumentation used for degenerative lumbar scoliosis can lead to several complications. In elderly patients without sagittal imbalance, dynamic stabilization could represent an option to avoid these adverse events. Methods. 57 patients treated by dynamic stabilization without fusion were included. All patients had degenerative lumbar de novo scoliosis (average Cobb angle 17.2¡ã), without sagittal imbalance, associated in 52 cases (91%) with vertebral canal stenosis and in 24 (42%) with degenerative spondylolisthesis. Nineteen patients (33%) had previously undergone lumbar spinal surgery. Results. At an average followup of 77 months, clinical results improved with statistical significance. Scoliosis Cobb angle was 17.2¡ã (range, 12¡ã to 38¡ã) before surgery and 11.3¡ã (range, 4¡ã to 26¡ã) at last follow-up. In the patients with associated spondylolisthesis, anterior vertebral translation was 19.5% (range, 12% to 27%) before surgery, 16.7% (range, 0% to 25%) after surgery, and 17.5% (range, 0% to 27%) at followup. Complications incidence was low (14%), and few patients required revision surgery (4%). Conclusions. In elderly patients with mild degenerative lumbar scoliosis without sagittal imbalance, pedicle screw-based dynamic stabilization is an effective option, with low complications incidence, granting curve stabilization during time and satisfying clinical results. 1. Introduction Degenerative lumbar scoliosis, also described as de novo or ¡°primary degenerative scoliosis¡± [1] is a frequent disease. Its incidence is reported to be from 6% to 68% [2¨C5] and increases with age [6]. These curves are located at thoracolumbar or lumbar level and need to be distinguished from degenerated preexisting idiopathic scoliosis; in fact, de novo scoliosis is developing after skeletal maturity without previous history of scoliosis. A recent prospective study [3] investigated 60 adults aged 50¨C84 years, without previous scoliosis. within 12 years, 22 cases (36.7%) developed de novo scoliosis with a mean angle of 13¡ã. A previous study reported a similar incidence: Robin et al. [7] followed 160 adults with a straight spine for more than 7 years and found 55 cases of de novo scoliosis (34.4%). Decreased bone density was initially considered to be the cause of de novo lumbar scoliosis [2]. At present, asymmetric degenerative changes of the disc, vertebral body wedging, and facet joint arthritis are held to be the predominant causes [1, 3, 7¨C9], disc degeneration appearing to be the starting
%U http://www.hindawi.com/journals/aorth/2013/365059/