Lumbar scoliosis and stenosis: What outcomes for which treatment? Analysis of three surgical techniques in 154 patients with minimum two-year follow-up

Abstract

Study design: Prospective multicentric study.

Objective: This study goal was to analyze the clinical and radiographic outcomes of lumbar stenosis and scoliosis (LSS) patients, treated with lumbar decompression (LD), short fusion and decompression (SF) or long fusion with deformity correction (LF).

Hypothesis: Procedures without correction lead to poorer long-term outcomes.

Methods: Consecutive patients with two-year minimum follow-up, older than 50, with lumbar scoliosis (Cobb angle>15°), and symptomatic lumbar stenosis were included. Age, gender, Lumbar and Radicular Visual Analog Scale, ODI, SF12 and SRS30 were collected. Main and adjacent curves Cobb angles, C7 coronal tilt (C7CT), spinopelvic parameters, and spino-sacral angle (SSA) were measured preoperatively, at one and two years. Patients were sorted into surgery type groups.

Results: In total, 154 patients were included, with respectively 18, 58 and 78 patients in LD, SF and LF groups. Mean age was 69, 85% were women. Clinical scores improved in each group at one year, but only LF group exhibited persistent improvement at 2years. A significant fractional Cobb angle increase was noted in the SF group at 2years (from 12±11° to 18±14°). C7CT significantly increased in the LD group at 2years (from 2.5±1.3° to 5.1±3.5°). LF group presented the highest complication rate (45%, 19% for SF and 0% for LD). The overall revision rate was 14% in SF group and 30% in LF group.

Conclusion: LSS is a complex pathology requiring custom-made surgical treatment. LD, SF and LF allow satisfactory clinical outcome, with a better and more sustained clinical improvement for LF despite higher complication and revision rates.

Level of evidence: IV.

Keywords: Adult spinal deformity; Decompression; Deformity surgery; Lumbar stenosis; Sagittal malalignment; Scoliosis.