Decompression Alone vs. Decompression with Limited Fusion for the Treatment of Degenerative Lumbar Scoliosis with Stenosis

Purpose: To analyze clinical results between decompression alone and decompression with limited fusion for the treatment of degenerative lumbar scoliosis (DLS) with stenosis.

Methods: 54 patients who underwent decompression alone (n=16) or decompression with instrumented fusion of one or two levels (n=38) were analyzed. Clinical results graded by length of initial good result until recurrence and patients' self-reported satisfaction were compared at 2 years postoperative. Excellent grading was given when symptom-relief persisted more than 2 years postoperative. Radiographs were evaluated relative to curve progression and adjacent segment breakdown.

Results: (See Table) Average follow-up was 4.9 years in the decompression group vs. 5.3 years in the fusion group (p=0.593). Average age at surgery was 74 years (range 64-87) in the decompression group and 65.7 (range 44-79) in the fusion group (p=0.002). At 2 years postoperative, clinical satisfactory results (good to excellent) were found in 10 out of 16 (62%) decompression patients vs. 33 out of 38 (87%) fusion patients (p=0.06). At 5 years postoperative, 37% (3/8) of the decompression group were symptom-free compared with 63% (12/19) of the fusion group (p=0.398). In the decompression group, 12 out of 16 patients developed recurrence of spinal stenosis at the previous decompression site and five recurred within six months postoperative. In fusion group, 13 out of 38 patients had recurrent stenosis at an adjacent segment (p=0.01) (table). Radiographic adjacent segment degeneration was observed in 45% (17/38) of patients who had limited fusion, eight (47%) of which had symptomatic spinal stenosis.

Conclusion: Recurrence of stenosis after very short-term symptom-relief was common following decompression alone. Adjacent segment breakdown was common in the fusion group, but less than half had associated stenosis. Because transition syndrome was less problematic than postoperative instability, limited fusion appears to be a better strategy than decompression alone for the treatment of DLS with stenosis.