Degenerative scoliosis - Options for surgical management

As the size of our aging population increases, some of the most challenging patients to treat will be ones with degenerative scoliosis. Degeneration of the facets and discs, which leads to the rotary and translational listhesis, is thought to be the starting point of the domino effect that leads to scoliosis. The spinal curvature usually seen in the lumbar or thoracolumbar spine appears to have more lateral and rotary listhesis with smaller Cobb angles than the long smooth curves seen in patients with adult idiopathic scoliosis. In the sagittal plane, moreover, loss of lordosis or even kyphosis with the patient leaning forward is common. Neural compression arising from a combination of listhesis, ligamentum hypertrophy, facet hypertrophy, and disc collapse results in radicular or neurogenic claudication symptoms. These patients request treatment of their spine more often for the neurogenic pain than the back pain or deformity. The advanced age of a patient adds additional challenges and risks to surgical management of the symptoms. For example, cardiopulmonary deficiencies and other medical comorbidities increase the complication rate of these patients. The bone density is usually decreased and is the weak link in the bone metal interface. Soft tissue contractures (eg, hips and pelvis) and overall decrease in flexibility reduce the ability of achieving and maintaining correction. metabolic bone disease (eg, osteoporosis and osteomalacia). The original thought was that the weakening bones collapse and result in degenerative scoliosis [1]. Subsequently, single- and dual-photon densitometry measurements taken in degenerative scoliosis and adult idiopathic scoliosis patients did not show a significant difference in bone mineral density between the two groups [2].