Degenerative lumbar scoliosis: added value of coronal images to routine lumbar MRI for nerve root compromise

Radiographic parameter differences in degenerative scoliosis with/without degenerative lumbar spondylolisthesis

OBJECTIVE

To investigate the imaging differences between degenerative scoliosis (DS) with or without degenerative lumbar spondylolisthesis (DLS).

METHODS

124 patients who underwent DS correction were enrolled in this study. Group A comprised 58 patients with DS with DLS, and group B comprised 66 patients with DS without DLS. Preoperative, postoperative, and 2-year follow-up coronal and sagittal imaging parameters were measured. The patients were classified in accordance with the SRS-Schwab classification, Schwab classification, and modified Abelin-Genevois classification. Clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) scores, visual analog scale (VAS) scores for pain, and the Oswestry disability index (ODI) scores.

RESULTS

The primary affected vertebrae in group A were the L3/4 segment (53.4%), whereas in group B, the L2/3 or L3/4 segments (42.4% and 39.3%, respectively) were affected. In the Schwab classification, most patients in group A were classified as type III, and most patients in group B were classified as type II (P < 0.05). In the modified Abelin-Genevois classification, most patients in group A were classified as grade AG4, but group B were most classified as grade AG3 (P < 0.05). Preoperative CVA, Cobb angle, apical vertical rotation, and SVA were larger in group A than those in group B, whereas LL and DH were smaller (P < 0.05). Preoperative Cobb angle, CVA, and SVA were larger in patients with grade II spondylolisthesis in group A, whereas LL was smaller(P < 0.05).

CONCLUSION

Compared with DS without DLS, DS with DLS is associated with greater preoperative coronal and sagittal imbalance; larger CVA, SVA, and Cobb angle; and smaller LL. Differences in CVA, SVA, Cobb angle, and LL were more obvious with high DS severity.

Poland Syndrome and Multimorbidity in a 79-Year-Old Male

This case study highlights a 79-year-old man with chronic low back pain attributed to severe lumbar scoliosis. Physical examination revealed the unilateral absence of pectoral muscles and ipsilateral hand anomalies, indicative of Poland syndrome (PS). The patient also experienced depression due to chronic pain and PS-related anomalies. A multi-disciplinary approach proved effective in alleviating both pain and depression.

Treatment of degenerative lumbar scoliosis using transforaminal lumbar interbody fusion based on the concept of intervertebral correction

PURPOSE

The study aimed to examine the outcomes of posterior approach transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS) based on the concept of intervertebral correction.

METHODS

A retrospective analysis was performed on 76 surgical patients (36 males and 40 females) who underwent posterior TLIF and internal fixation based on the concept of intervertebral correction in Shenzhen Traditional Chinese Medicine Hospital from February 2014 to March 2021.The operation duration, intraoperative blood loss, incision length, and complications were recorded. Clinical efficacy was evaluated preoperatively and postoperative time points through the visual analog scale (VAS) and the Oswestry disability index (ODI). The changes in the coronal scoliosis curve (Cobb angle), coronal balance distance (CBD), the sagittal vertical axis (SVA), lumbar lordosis (LL), and pelvic tilt angle (PT) were assessed perioperatively at the last follow-up.

RESULTS

All patients successfully underwent the operation. The average operation duration was 243.81 ± 35.35 (220 - 350) min; the average intraoperative blood loss was 836.27 ± 50.28 (700 - 2500) mL; the average incision length was 8.30 ± 2.33 (8 - 15) cm. The total complication rate was 18.42% (14/76). The VAS score of low back pain, lower extremity pain, and ODI score of patients at the last follow-up was significantly improved compared with those before the operation (P < 0.05). At the last follow-up, the Cobb Angle, CBD, SVA, and PT of patients were significantly lower than those before the operation (P < 0.05), and LL was higher than those before the operation (P < 0.05).

CONCLUSION

TLIF based on the concept of intervertebral correction for the treatment of DLS may provide favourable clinical outcomes.

Feasibility Analysis of 3D Printing-Assisted Pedicle Screw Correction Surgery for Degenerative Scoliosis

Objective. To explore the feasibility of 3D printing-assisted pedicle screw correction surgery for degenerative scoliosis. Methods. From January 1, 2015 to January 31, 2020, patients with degenerative scoliosis who received corrective surgery in our hospital were retrospectively analyzed. Patients were grouped based on the fixation methods. Patients in the control group received traditional pedicle screw internal fixation, while those in the study group received 3D printing-assisted pedicle screw fixation. The therapeutic effects were compared. Results. There were 78 cases in the control group and 82 cases in the study group. There were no significant differences in scoliotic Cobb’s angle, pelvic incidence-lumbar lordosis (PI-LL), VAS score, JOA score, social function, physical function, role function, or cognitive function between the study group and the control group before the surgery, but there were differences in the above parameters between the two groups after surgery. The incidence of postoperative complications in the study group was also significantly lower in the study group. Conclusion. 3D printing-assisted pedicle screw correction surgery provides a strong 3D correction force with reliable effect and fewer complications, and is a good treatment choice for degenerative scoliosis.