Less invasive surgical correction of adult degenerative scoliosis, part I: technique and radiographic results

Neurosurgery
Kai-Michael ScheuflerAnke Eckardt

Abstract

Adult scoliosis is a condition with increasing prevalence and medical and socioeconomic importance. Surgery is fraught with a significant complication rate in an elderly multimorbid patient population. To assess technical feasibility and radiographic results of image-guided less invasive correction of adult degenerative scoliosis. Thirty individuals (age, 64-88 years) with progressive deformity (coronal Cobb angles > 25 degrees and < 85 degrees), intractable back pain, radiculopathy, or neurogenic claudication were treated by less invasive decompression and fusion (unilateral transforaminal interbody cage instrumentation and bilateral facet fusions) with recombinant human bone morphogenetic protein-2, spanning 3 to 8 segments (average, 6 segments), using biplanar fluoroscopy or intraoperative computed tomography (iCT)-based navigation. Accuracy of screw placement, curve correction, and fusion rate were evaluated during a mean follow-up of 19.6 months. With 415 screws implanted, misplacement (grade II or greater) was not observed, and no implants required revision. Spinal iCT with automated registration required 17.5 +/- 8.5 minutes (single registration for all segments); monosegmental bilateral screw insertion required 6.8 +/- ...Continue Reading

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