Safdar Khan, MD - - Orthopedics Orthopedics Safdar Khan, MD H. - - PowerPoint PPT Presentation

Safdar Khan, MD Safdar Khan, MD -

• Orthopedics

Orthopedics

• H. Francis Farhadi, MD, PhD
• H. Francis Farhadi, MD, PhD -
• Neurosurgery

Neurosurgery

• 68 yro F with leg >

back pain

• Worse on the right

and with standing/walking

• ODI 54%
• Failed PT and

injection trials

• Scoliosis +

Spondylolisthesis

• Unstable lateral

spondylolisthesis at L2-L3

• Stable anterior

spondylolisthesis at L4-L5

• 1 yr post-op
• VAS back

and leg 0/10

• ODI 20%

Deformity in Coronal and Sagittal Planes

• Incidence: 2.5-15%
• Degenerative changes in the

intervertebral discs, facets, and

• steoporosis
• Associated with spondylolisthesis,

lateral subluxation, and sagittal imbalance

• Clinical presentation: LBP,

neurogenic claudication, radiculopathy, flat-back syndrome

• Treatment
• Conservative: NSAIDs,

analgesics, PT, brace, injections

• Surgery

Degenerative Scoliosis

• Surgical Indications
• Failure of conservative

treatment

• Significant and progressive

spinal deformity

• Functionally disabling

neurological deficits

• Surgical Techniques
• Decompression alone
• Decompression plus fusion

(extent of fusion, correction

• f deformity, posterior vs.

anterior/posterior)

Degenerative Scoliosis

• Degenerative scoliosis

presents with varying degrees

• f curve magnitudes and

stenosis

• Pritzell, Simmons,

Dawson, Schwab, etc

• Ploumis et al, 2008 (mild

Grade I, moderate with lateral listhesis Grade II, and severe with global imbalance Grade III)

• Individualized treatment in

terms of levels of fusion, extent of instrumentation, anterior/posterior approaches.

Pitfalls (Patient Evaluation)

• Clinical symptoms are more

important than imaging findings

• Distinguish deformity vs.

degenerative

• Assess both primary and fractional
• r compensatory curvature
• Assess sagittal alignment but

distinguish flat-back deformity from lumbar stenosis presenting as sagittal imbalance

Conclusions

• Degenerative scoliosis presents with

varying degrees of curve magnitudes and stenosis

• Individualized treatment in terms of levels
• f fusion, extent of instrumentation,

anterior/posterior approaches.

• Decompression only
• Laminectomy plus fusion with or

without instrumentation

• A/P and/or osteotomy for curve

correction for global imbalance

• Newer techniques
• XLIF and minimally invasive posterior

decompression and fusion

• Motion preservation (ie, TDR, etc)

Discussion and Questions