Diagnosis and Treatment of Degenerative Lumbar Scoliosis with Root Pain

Abstract

Introduction Degenerative lumbar scoliosis is a common type in degenerative lumbar disease. In clinic, root pain is very general except back pain. The objective of our research is to explain and summarize which segments frequently occur root pain, what is the diagnosis methods, and significance of surgical treatment. Materials and Methods The research included retrospectively 46 patients suffering degenerative lumbar scoliosis with root pain, undergoing surgical treatment in our hospital during May 2005 to September 2009, all of them have complete follow-up data. The segments of root pain were judged through physical examination, radiography, and selective nerve root injection. According to the the scoliosis type and degree, we chose different surgical procedures, (1) simple decompression, (2) decompression with short segment fixation, (3) decompression and orthopedics with long segment fixation. The patients’ radiographic results were analyzed by X-ray and MRI, functional conditions were evaluated by Oswestry disability index (ODI) and visual analog scale (VAS). Results The research included 46 patients, the average follow-up was 5.8 years. Male patients were 20, and female patients were 26 in our research. According to segments of root pain: L2-3 (4 patients), L3-4 (9 patients), L4-5 (21 patients), L5-S1 (12 patients); surgical procedures: simple decompression (4 patients), decompression with short segment fixation (35 patients), decompression and orthopedics with long segment fixation (7 patients). A total of 42 patients had bony fusion by radiography. In scoliosis orthopedics group, the cobb angle dropped from 19.3 ± 15.2 degrees preoperatively to 9.2 ± 5.3 degrees at final follow-up. ODI of all patients dropped from 59.22 ± 22.31 preoperatively to 15.23 ± 11.12; and VAS dropped from 7.3 ± 1.8 to 2.3 ± 1.4 at final follow-up, respectively. Conclusion (1) Root pain of degenerative lumbar scoliosis usually located to the segment, which just under the bulge side (39/46, 84.8%), rather than concave side. (2) Radiography and selective nerve root injection were helpful to ensure the pain segment and position. (3) Most degenerative lumbar scoliosis patients undergoing root pain can proceed simple decompression or decompression with short segment fixation, only few patients need to proceed decompression and orthopedics with long segment fixation. Disclosure of Interest None declared