Degenerative Scoliosis
Spinal deformity is the abnormal alignment of the spine due to wear and tear (degenerative) changes of the disc space and the facet joints. It may also be related to previous spinal surgery. The abnormal alignment may be seen as a side to side curve (scoliosis), a forward hunch (kyphosis) or an exaggerated backward curve (swayback or hyper-lordosis)
Symptoms
There is a spectrum of symptoms, from a painless deformity to crippling loss of function and respiratory restrictions.
Symptoms include:
- Back pain
- Loss of normal posture and balance
- Leg pain from nerve root irritation
- Weakness of lower limb
- Inability to walk
- Inability to maintain forward gaze
- Progressive hunch due to muscle fatigue
Diagnosis
Diagnosis is confirmed on standing 3-foot Xrays, EOS scan, CT and MRI scans. The history from the patient related to impact on quality of life, and the progression over time will assist in determining what treatment may be appropriate.
Treatment
Nonsurgicalsolutions will include:
- Use of walking aids (wheelie-frame)
- Analgesia and pain management
- Physical therapy
- Osteoporosis treatment
Thoraco-lumbar bracing used in paediatric (flexible) scoliosis is usually unhelpful in adult degenerative (stiff/fixed) scoliosis
Surgical solutions may include a combination of:
- Limited decompression (foraminotomy, laminotomy, hemilaminectomy or laminectomy)
- Correction of deformity (interbody devices, facet removal, osteotomies, vertebrectomies)
- Internal fixation (pedicle screws, hooks, bands, iliac fixation, cement augmentation)
- Bone grafting
- Performed “Open”, “MIS” (minimally invasive), combination of open and MIS (Hybrid)
- Peformed using Fluroscopy, Navigation, or Robotic-Assisted
