The surgical outcome of decompression alone versus decompression with limited fusion for degenerative lumbar scoliosis

OBJECTIVE The aim of this study was to assess the usefulness of radiological parameters for surgical decision-making in patients with degenerative lumbar scoliosis (DLS) by comparing the clinical and radiological results after decompression or decompression and fusion surgery. METHODS The authors prospectively planned surgical treatment for 298 patients with degenerative lumbar disease between September 2005 and March 2013. The surgical method used at their institution to address intervertebral instability is precisely defined based on radiological parameters. Among 64 patients with a Cobb angle ranging from 10 degrees to 25 degrees, 57 patients who underwent follow-up for more than 2 years postoperatively were evaluated. These patients were divided into 2 groups: those in the decompression group underwent decompression alone (n = 25), and those in the fusion group underwent decompression and short segmental fusion (n = 32). Surgical outcomes were reviewed, including preoperative and postoperative Cobb angles, lumbar lordosis based on radiological parameters, and Japanese Orthopaedic Association (JOA) scores. RESULTS The JOA scores of the decompression group and fusion group improved from 5.9 +/- 1.6 to 10.0 +/- 2.8 and from 7.2 +/- 2.0 to 11.3 +/- 2.8, respectively, which was not significantly different between the groups. At the final followup, the postoperative Cobb angle in the decompression group changed from 14 degrees +/- 2.9 degrees to 14.3 degrees +/- 6.4 degrees and remained stable, while the Cobb angle in the fusion group decreased from 14.8 degrees +/- 4.0 degrees to 10.0 degrees +/- 8.5 degrees after surgery. CONCLUSIONS The patients in both groups demonstrated improved JOA scores and preserved Cobb angles after surgery. The improvement in JOA scores and preservation of Cobb angles in both groups show that the evaluation of spinal instability using radiological parameters is appropriate for surgical decision-making.