[Posterior approach to treatment of spinal stenosis associated with degenerative lumbar scoliosis].
OBJECTIVE
To discuss the main points of techniques and ranges of fusion in posterior operation of degenerated lumbar scoliosis complicated spinal stenosis.


METHODS
From February 2001 to September 2006, 23 cases with degenerated lumbar scoliosis stenosis were treated by posterior operation. There were 9 males and 14 females, with the average age of 65.3 years (ranging from 52 years to 71 years). The course of the diseases was 4 to 8 years. All patients were presented with severe low back pain. All patients were measured for Cobb angle of curves(17 degrees to 53 degrees), and lordosis angle of lumbar (-20 degrees to 10 degrees 10 cases, -40 degrees to -20 degrees 13 cases). Ten cases in which Cobb angle was smaller than 20 degrees were operated by limited segmental decompression of spinal canal, posterior intervertebral fusion and short transpedical instrument fixation. For the rest 13 cases in which Cobb angle was bigger than 20 degrees were operated by canal decompression, longer instrument for scoliosis correction, intervertebral fusion and posterior-lateral fusion. The fixation and fusion were located at L4-S1 in 6 cases, L1-5, in 5, L2-5 in 4, L1-S1 in 5, L2-S1 in 2 and T10-S1 in 1.


RESULTS
There was no patient who died from the operation. Average Cobb angle in coronal plane was 0 degrees to 21 degrees with the average of 15.6 degrees. The lumbar lordosis angle was -48.0 degrees to -18.2 degrees with the average of 36.4 degrees. There were 21 cases (91%) with sciatica and intermittent claudication who were clearly released. There were 20 cases (87%) whose low back pain intensely decreased. Three cases with drop-foot returned to normal activities. During the mean 15-month (6 to 54 months) follow-up for 23 cases, there was no change of corrected results and fusion rate was 100%.


CONCLUSIONS
For degenerated lumbar scoliosis patients, the most important purpose of the treatment is to improve clinical symptoms through sufficient decompression of neural structures. Lumbar stabilization reconstruction and benign spinal biomechanics line conduct to long-term curative effect. Overall estimate of the clinical appearances and imageology characters is necessary when the decision, that segments are needed to be fixed and fused should be made. The strategy of the individualized treatment may be the best choice.
Xie
Jingming
J
Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical College, Kunming Yunnan, 650101, P.R.China. xiejingming@vip.163.com
Zhang
Ying
Y
Wang
Yingsong
Y
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*