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

Khalifé, Marc; Charles, Yann-Philippe; Riouallon, Guillaume; Lafage, Renaud; Sabah, Yann; Hardy, Laura Marie; Guigui, P.; Zakine, S.; Ferrero, Emmanuelle

doi:10.1016/j.otsr.2023.103632

Cited by 3 publications

(8 citation statements)

References 25 publications

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“…As previously noted, long-segment fusion has been shown to have a stronger ability to provide both sagittal and coronal correction of spinal deformity compared to shortsegment fusion and decompression constructs [2][3][4][5][6][7]. However, long-segment instrumented fusion has also been shown to carry a significant burden of post-operative morbidity and disability in comparison to more limited interventions [2,3,[5][6][7][8][9][10][11]. Thus, in cases of compensated deformity, where given a balanced deformity, sagittal correction is not the primary aim of treatment, short-segment fusion and decompression can provide adequate symptomatic relief [4].…”

Section: Short-segment Fusion: Does It Provide Relief?mentioning

confidence: 88%

“…Song et al noted significantly higher rates of complications, including nonunion, in patients undergoing long-segment instrumented fusion, findings affirmed by Khalifé et al [6,7]. Schairer et al demonstrated a higher risk of readmission in patients who underwent long-segment fusion [8].…”

Section: Long-segment Fusion: Advantages and Drawbacksmentioning

confidence: 91%

Section: Short-segment Fusion: Does It Provide Relief?mentioning

confidence: 97%

“…Song et al found in a cohort followed for 4 years that Cobb angles, lumbar lordosis, sagittal balance, and coronal balance were all significantly better following long-segment fusion (average 7.9 ± 2.1 levels) [6]. Khalifé et al noted that long-segment constructs were significantly better at fixing Cobb angles, fractional curves, lumbar lordosis, pelvic incidence-lumbar lordosis (PI-LL) mismatch, pelvic tilt (PT), and spinosacral angles (SSA) [7]. Overall, long-segment instrumented fusion is better at restoring coronal and sagittal balance, while limited interventions remain ill-equipped to restore spinal balance.…”

Section: Long-segment Fusion: Advantages and Drawbacksmentioning

confidence: 99%

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Limited Intervention in Adult Scoliosis—A Systematic Review

Mohammed,

Worley,

Hiatt

et al. 2024

JCM

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Background/Objectives: Adult scoliosis is traditionally treated with long-segment fusion, which provides strong radiographic correction and significant improvements in health-related quality of life but comes at a high morbidity cost. This systematic review seeks to examine the literature behind limited interventions in adult scoliosis patients and examine the best approaches to treatment. Methods: This is a MEDLINE- and PubMed-based literature search that ultimately included 49 articles with a total of 21,836 subjects. Results: Our search found that long-segment interventions had strong radiographic corrections but also resulted in high perioperative morbidity. Limited interventions were best suited to patients with compensated deformity, with decompression best for neurologic symptoms and fusion needed to treat neurological symptoms secondary to up-down stenosis and to provide stability across unstable segments. Decompression can consist of discectomy, laminotomy, and/or foraminotomy, all of which are shown to provide symptomatic relief of neurologic pain. Short-segment fusion has been shown to provide improvements in patient outcomes, albeit with higher rates of adjacent segment disease and concerns for correctional loss. Interbody devices can provide decompression without posterior element manipulation. Future directions include short-segment fusion in uncompensated deformity and dynamic stabilization constructs. Conclusions: Limited interventions can provide symptomatic relief to adult spine deformity patients, with indications mostly in patients with balanced deformities and neurological pain.

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Section: Short-segment Fusion: Does It Provide Relief?mentioning

confidence: 88%

Section: Long-segment Fusion: Advantages and Drawbacksmentioning

confidence: 91%

Section: Short-segment Fusion: Does It Provide Relief?mentioning

confidence: 97%

Section: Long-segment Fusion: Advantages and Drawbacksmentioning

confidence: 99%

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Limited Intervention in Adult Scoliosis—A Systematic Review

Mohammed,

Worley,

Hiatt

et al. 2024

JCM

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“…Lumbar stenosis and scoliosis with or without spondylolisthesis are common but complex pathologies that occur in aging adult patients and may cause low back pain and leg pain. Among the treatments for this disease, lumbar decompression, fusion and decompression, or long fusion with deformity correction have been shown to yield satisfactory clinical outcomes; however, long fusion with deformity correction can result in better and more sustained clinical improvement, although the occurrence of complications and revision rates are high 2 . However, for spinal stenosis with balanced de novo degenerative lumbar scoliosis, short fusion, or the fusion of 1–2 levels without curve correction, has been shown to be a reasonable option because of its advantages in decreasing blood loss and reducing operative time compared with long fusion with curve correction and fusion (≥3 levels) with attempted curve correction 3 .…”

mentioning

confidence: 99%

Practice for the treatment of noncontiguous double-level lumbar spinal stenosis with degenerative spondylolisthesis and scoliosis with Endo-LIF

Chen,

Ma,

Zhang

2024

International Journal of Surgery

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The selection of a surgical strategy for the treatment of adult degenerative scoliosis with "pear-shaped" decompression under open spinal endoscopy

Wang,

Liu,

et al. 2024

Sci Rep

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The prognoses of patients who undergo open spinal endoscopy (OSE) decompression significantly differ by scoliosis type and symptom despite the use of uniform standards and procedures for the decompression surgery. These differences may be directly related to the selection and formulation of surgical strategies but their cause remains unclear. The aim of this study was to verify and evaluate the efficacy of the "Symptom, Stenosis and Segment classification (SSS classification)" in determining an appropriate surgical strategy and to analyze the differences in the outcomes of different patients after receiving the selected surgical strategy. The results of this study ultimately provide a theoretical basis for the specific optimization of surgical strategies guided by the "SSS classification". This work was a retrospective study. We reviewed 55 patients with scoliosis and spinal stenosis who underwent "pear-shaped" decompression under OSE from May 2021 to June 2023 treated by our surgical team. To classify different types of patients, we defined the "SSS classification" system. The permutation and combination of subtypes in Symptom (including three subtypes: Convex = v, Concave = c and Bilateral = b), Stenosis (including three subtypes: Convex = v, Concave = c and Bilateral = b), and Segment (including two subtypes: Edge = e and Inside = i) yields 18 possible types (details in Table 1) in this classification system. To classify different types of surgeries, we also defined the operation system. The VAS Back and VAS Leg scores after surgical treatment were significantly lower in all patients 3 months after surgery than before surgery. (**P < 0.05). The Svve type accounted for the greatest proportion of patients (62.50%) in the VAS back remission group, and the Scce type accounted for the greatest proportion (57.14%) in the VAS back ineffective group. According to the VAS leg score, the percentage of patients in whom Svve was detected in the VAS leg remission group reached 60.87%, and the percentage of patients in whom Svve was detected in the VAS leg ineffective group reached 44.44%. Svve accounted for the greatest proportion of cases (61.22%) in the JOA-effective group, and Scce accounted for the greatest proportion of cases (50.00%) in the JOA-ineffective group. In the JOA-effective group, the Ovv type accounted for the greatest proportion (up to 79.59%), while in the JOA-ineffective group, Occ and Ovv accounted for 50.00% of the cases each. The proportions of Svve type were the highest in the healthy group (up to 60.00%) and the ODI-effective group (up to 50.00%). The Ovv type accounted for the greatest proportion of patients in the ODI-effective group (up to 80.00%), and the Occ type accounted for the greatest proportion of patients in the ODI-ineffective group (up to 60.00%). Most of the surgical plans formulated by the "SSS classification" method were considered appropriate, and only when the symptoms of patients were located on the concave side did the endoscopic decompression plan used in the present study have a limited ability to alleviate symptoms.

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

Cited by 3 publications

References 25 publications

Limited Intervention in Adult Scoliosis—A Systematic Review

Limited Intervention in Adult Scoliosis—A Systematic Review

Practice for the treatment of noncontiguous double-level lumbar spinal stenosis with degenerative spondylolisthesis and scoliosis with Endo-LIF

The selection of a surgical strategy for the treatment of adult degenerative scoliosis with "pear-shaped" decompression under open spinal endoscopy

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