Adult Degenerative Scoliosis / Deformity
Degenerative scoliosis is a condition which generally occurs in older adults*, and is due to degeneration of the lumbar spine resulting in curvature and rotation of the spine. This can also occur in adults with preexisting idiopathic or adolescent scoliosis, or can occur as a result of previous spinal surgery/fusion. As opposed to children, adult scoliosis can be very painful and disabling and is often due more to the loss of sagittal alignment (stooped forward) rather than the coronal (face on) curve. These patients may have neurologic deficits from nerve root compression secondary to aging changes, but usually have significant underlying chronic back pain. Degenerative scoliosis is still best managed with non-surgical treatments, but if patients fail to improve, then surgery is a consideration, but we must weigh the risks and benefits very carefully.
Surgery for degenerative scoliosis is among the most difficult and complex spinal surgery that is performed today. Traditional open posterior surgery is done in one day, takes about 10 hours, and is associated with very high (~70%) complication rate. Our approach is less invasive, but it cannot be deemed minimally invasive, as it still takes 10 hours (split over 2 days). Complication rates are still high (~20%), given the age of the patients (and coexisting medical problems, including osteoporosis) and the difficult in correcting the deformity. Above is a picture of a patient with a spinal deformity (in part related to previous surgery), treated with our less invasive surgery and resulting in excellent correction of her sagittal balance.
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*We do not perform surgery on adolescents or young adults. Surgery for adult deformity is usually performed on patients in their 50’s-70’s (our mean age is 68).