Correction of adult scoliosis via a posterior-only approach.

OBJECT: Adult scoliosis is a pathologically different entity from adolescent idiopathic scoliosis. The curves are more rigid, and rotational deformity and multilevel sagittal vertebral slippages compound the coronal malalignment. To correct these deformities, a surgical anterior release procedure is usually required, as well as posterior instrumentation-assisted fusion. This exposes the patient to the risks of a second procedure and of a thoracotomy or laparotomy. To decrease these risks, the authors have performed an anterior release, posterior release, and reduction via a posterior-only approach. The purpose of this study was to analyze quantitatively the degree of pre- and postoperative coronal deformity, the extent of correction, and related complications.

METHODS: Data obtained in 20 patients with adult scoliosis were retrospectively studied. Patients presented with persistent back or lower-extremity pain, progressive deformity, or progressive neurological deficit. Sixteen patients underwent Gill-type laminectomy, radical discectomy (including fracture of any anterior and lateral osteophytes), and posterior lumbar interbody fusion (PLIF) of all apical and adjacent segments. One to four anterior release procedures were performed in each patient. Posterior instrumentation was placed over three to 15 levels. Autograft was obtained from the laminectomy sites and posterior iliac crest for fusion. There were no deaths; all patients were followed for a minimum of 1 year. The mean coronal Cobb angle improved from 36 degrees to 14.7 degrees. All spondylolisthetic lesions were reduced to at least Grade I. At the most recent follow-up examination, evidence of fusion was demonstrated in all patients. Reoperation for adjacent-segment failure, cephalad to the highest level of fusion, was required in two cases.

CONCLUSIONS: In many cases of adult scoliosis, a satisfactory multiplanar correction may be obtained via a single posterior approach and by using extended PLIF techniques. Cephalad adjacent-segment failure remains a significant problem in patients with osteoporosis, and routine extension of posterior instrumentation to the upper thoracic spine should be considered in these cases.