Less Invasive Surgical Correction of Adult Degenerative Scoliosis. Part II: Complications and Clinical Outcome

Neurosurgery 67:1609–1621, 2010 DOI: 10.1227/NEU.0b013e3181f918cf

Surgical correction of adult degenerative scoliosis is a technically demanding procedure with a considerable complication rate. Extensive blood loss has been identified as a significant factor linked to unfavorable outcome.

OBJECTIVE: To report on the complication profile and clinical outcomes obtained with less invasive image-guided surgical correction of degenerative (de novo) scoliosis in a high-risk population.

METHODS: Thirty patients (age, 64-88 years) with progressive postural impairment, back pain, radiculopathy, and neurogenic claudication caused by degenerative scoliosis were treated by less invasive image-guided correction (3-8 segments) by multisegmental transforaminal lumbar interbody fusion and facet fusions. With a mean follow-up of 19.6 months, intraoperative blood loss, curve correction, fusion and complication rates, duration of hospitalization, incidence of hardware-related problems, and clinical outcome parameters were assessed using multivariate analysis.

RESULTS: Satisfactory multiplanar correction was obtained in all patients. Mean intraoperative blood loss was 771.7±231.9 mL, time to full ambulation was 0.8 ± 0.6 days, and length of stay was 8.2 ± 2.9 days. After 12 months, preoperative SF12v2 physical component summary scores (20.2 ± 2.6), visual analog scale scores (7.5 ± 0.8), and Oswestry disability index (57.2 ± 6.9) improved to 34.6 ± 3.9, 2.63 ± 0.6, and 24.8 ± 7.1, respectively. The rate of major and minor complications was 23.4% and 59.9%, respectively. Ninety percent of patients rated treatment success as excellent, good, or fair.

CONCLUSION: Less invasive image-guided correction of degenerative scoliosis in elderly patients with significant comorbidity yields a favorable complication profile. Significant improvements in spinal balance, pain, and functional scores mirrored expedited ambulation and early resumption of daily activities. Less invasive techniques appear suitable to reduce periprocedural morbidity, especially in elderly patients and individuals with significant medical risk factors.