Surgical Management of Spinal Stenosis with Degenerative Lumbar Scoliosis

Kim, Ki Soo; Choi, Young Soo; Song, Jin Ann; Kim, Do Yong

Abstract

The coexistence of spinal stenosis and scoliosis in lumbar spines is becoming a more frequent problem in elderly persons. Decreased bone mass in most of these patients also complicates their management. Recently, the pedicle screw instrumentation systems offer the way to solve these difficult problems. Most of the cases with degenerative scoliosis itself don't require surgical intervention. However, the case with severe clinical manifestations need surgery. From Jan. 1988 to Oct. 1993, authors had treated operatively for 15 cases of spinal stenosis with degenerative lumbar scoliosis. After adequate posterior decompression, pedicular instrumentation was carried out and correction of scoliotic deformity was attempted. Cotrel-Dubousset instrumentation was used in six patients, Graf instrumentation in three patients, and combined(Steffee and Graf) instrumentation in six patients. Follow up was obtained at an average of 20.4 months(Range; 10 - 57 months), and clinical assessment according to author's criteria was satisfactory(Excellent/Good) in 14 cases(93.3%). The Graf instrumentation or the combined instrumentation(Steffee and Graf) have a lot of advantages such as correction of scoliotic deformity, restoration of lumbar lordosis and less operative risks. These results suggest these pedicle instrumentations are good surgical method for spinal stenosis with degenerative lumbar scoliosis in cautiously selected cases.