MIS Treatment of Adult Lumbar Degenerative Scoliosis
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About Adult Degenerative Scoliosis
With age, the spine becomes susceptible to degenerative changes. Biochemical changes, wear and tear, congenital disorders, childhood scoliosis, prior injuries or metabolic diseases all contribute to spinal degeneration and alter spinal biomechanics. Common disorders such as spinal stenosis, degenerative disc disease, osteoporosis, and vertebral compression fractures affect the integrity and stability of spinal structures and may cause lumbar degenerative scoliosis.
Scoliosis causes the spine to curve abnormally to the left or right. The curvature may remain stable or progress and cause the spine to rotate. Because the causes of adult lumbar degenerative scoliosis are broad, diagnosis by a MIS spine surgeon is essential.
Important to a proper diagnosis is the patient?s medical history, physical and neurological examination, and imaging studies.
- Medical history includes knowing if other family members have scoliosis, symptoms, their severity, and treatments already tried.
- Physical and neurological examination includes evaluating movement limitations, balance problems, pain, extremity reflexes, muscle weakness, and sensation. The exam may include a series of movements such as bending sideways, forward and backward at the waist, and walking.
- Imaging studies may include standing x-rays (front/back, side). Side bending x-rays are sometimes helpful to evaluate spinal flexibility and access overall alignment. In addition, if necessary, a CT scan, MRI, or myelography is performed.
When MIS is Recommended
Besides curve severity and symptoms, there are other considerations before surgery is recommended, if at all. Although the indications for surgery vary, MIS may be recommended if:
- Imaging tests demonstrate spinal instability, a large curve, or curve progression
- Pain and other symptoms worsen and are unresponsive to nonoperative treatment
- Pain and symptoms significantly affect quality of life
- Neurologic problems develop, such as bowel or bladder dysfunction
- Deformity increases to the point where it becomes difficult to stand upright
- Imaging tests, such as x-ray or MRI demonstrate spinal instability or curve progression
Surgical goals include:
- Stabilize the spine, prevent curve progression
- Decompress spinal nerves (relieve pressure)
- Correct deformity
Surgery may include combined procedures such as decompression, fusion and instrumentation.
- Decompression procedures relieve pressure on spinal nerves. Discectomy (disc removal), laminotomy, laminectomy, and foraminotomy are common procedures. Laminotomy (partial removal) and laminectomy (complete removal) involve removing the vertebral body?s lamina to increase the size of the spinal canal. The lamina is a section of bone near each facet joint covering access to the spinal canal. Foraminotomy expands the foramen or spinal nerve passageways.
- Spinal fusion uses bone graft to fuse or join two or more vertebrae. Fusion is often combined with instrumentation, such as interbody devices (i.e. cage), pedicle screws and rods, to immediately stabilize the spine until the construct fuses.
- Deformity correction involves restoring the spine to a more normal alignment and fixing the spine in position using fusion and instrumentation.
Minimally spine surgery procedures approach the spine from the front (anterior), back (posterior), side (lateral), or back and side (posterolateral). Procedures such as those listed below share the same surgical goals:
- Anterior Lumbar Interbody Fusion (ALIF)
- Direct Lateral Interbody Fusion (DLIF / XLIF)
- MIS Transforaminal Lumbar Interbody Fusion (TLIF)
The interbody device, such as a Titanium cage or PolyEtherEther Ketone (PEEK) spacer, is implanted into the disc space. Bone graft is packed into and around the device to stimulate spinal fusion.
- ALIF provides access to the spine through the abdomen. This procedure is often combined with posterior fusion and instrumentation for better spinal fixation.
- DLIF / XLIF provides access to the spine through the side of the body. This procedure involves a transpsoas approach, which means the surgeon accesses the spine through the psoas muscle; a long muscle on either side of the lumbar spine.
- TLIF provides access to both sides of the disc through the intervertebral foramina, small passageways through which nerves exit the spinal canal. An interbody device, such as a cage or spacer is implanted into the disc space from one side of the spine. Pedicle screws and rods, with additional bone graft, secure the back (posterior) section of the spine. TLIF fuses the front and back sections of the spine.
MIS for scoliosis; before and after x-rays
Postoperative scars are minimal
Risks and Complications
No patients are identical and risks and complications vary. Your surgeon will explain possible risks and complications related to your specific MIS procedure.