The surgical management of degenerative lumbar scoliosis. Posterior instrumentation alone versus two stage surgery.

Twenty-one patients who underwent surgery for degenerative scoliosis were retrospectively reviewed. Eleven patients underwent staged anterior and posterior surgery. Ten patients had a single posterior procedure. Posterior instrumentation to the sacrum was done in all cases. Average length of follow-up was 3.8 years (range: 2 to 7 years). All patients were assessed by the Oswestry Disability Questionnaire and Low-Back Outcome Score. Additional questions included analogue scales for pain and quality of life, and self-rating of the outcome of treatment. Nine patients that had two stage surgery and 4 patients that had single posterior surgery considered their outcome to be good or excellent (p = 0.13). This correlated with better functional tolerance, specifically sleep, lifting, sitting, and social life. Although pain intensity was the same for both groups, only the staged group reported significant reduction in analgesic intake. Significant correction in scoliosis and the lumbosacral fractional curve was noted only following staged surgery. A solid spinal fusion determined a satisfactory outcome irrespective of the method of treatment. Staged anterior and posterior surgery for degenerative lumbar scoliosis resulted in a better fusion rate, greater correction of deformity, and more improvement in function than did posterior surgery alone.