Personalized Surgical Treatment For Adult Degenerative Scoliosis

[Objective] To investigate clinical outcomes of Personalized surgical treatment for adult degenerative scoliosis.[Methods] Thirty-four patiens with adult degenerative scoliosis who underwent posterior approach surgical treatment from January 2009 to March 2013 were retrospectively reviewed.All cases were collected the change of clinical history, radiographic parameters,and functional assessment parameters in the course of pre-operation, 3 months postoperatively and at the final follow-up.According to the range of fusion,these cases were divided into short segment group and long segment group. Radiographic parameters were measured by the whole spine lateral X-rays, the condition of balance in the coronal plane, sagittal plane, axial plane and pelvis was observed, including coronal Cobb angle(CCA),coronal sacral vertical line(CSVL), lateral olisthesis(LO),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic tilt(PT).Japanese Orthopaedic Association(JOA) lumbar disease function scores and Oswestry Disability Index(ODI) scores were used to evaluate the function improvement.[Results] The patients(11 males,23 females) were followed up for a mean of(15.4±6.1)months, the mean age of the patients was(65.7±10.5)years when operation. Short segment group had 22 cases and long segment group had 12 cases.Symptoms of patients were improved after surgical treatment. JOA scores and OD scores of all cases were(10.53±1.08)scores、(40.34±9.65)scores pre-operatively,(25.82±1.31)scores、(15.76±8.81)scores at 3 months postoperatively,(24.93±1.23)scores、(16.25±6.49)scores at the final follow-up;Imbalance in the coronal plane, sagittal plane, axial plane and pelvis was improved after surgical treatment, CCA、LL、PT of all cases were(26.56±8.08)°、(25.41±13.03)°、(21.32±8.51)°pre-operatively,(16.01±2.04)°、(33.64±11.63)°、(18.85±7.64)°at 3 months postoperatively,(15.23±2.74)°、(34.04±11.42)°、(18.07±7.91)°at the final follow-up.There wasstatistic difference between 3 months postoperative data and pre-operative data(P<0.05). There was statistic difference between the final follow-up data and pre-operative data(P<0.05).Packet analysis, short segment group and a long segment were obtained satisfactory clinical effect, long segment group in terms of deformity correction was better than that of short segment group, short segment group had less impact of surgery and internal fixation related complications than long segment group.The parameters of spine and pelvis were correlated with the JOA and ODI.[Conclusions] Adult degenerative scoliosis was a complicated illness, the main purpose of surgical was to alleviate symptoms, then stabilize and maintain spinal balance,according to the clinical and radiological characteristics of patients with different personalized surgical treatment can achieve satisfied clinical outcomes.