Abstract
BackgroundNo studies have evaluated the long-term results of non-surgical and surgical management in de novo degenerative lumbar scoliosis (DNDLS). This study reports on the long-term functional outcome of patients being treated for DNDLS by non-surgical and surgical management.MethodsThis is a retrospective review of a single center database of DNDLS patients that underwent surgical or usual non-surgical management between 1996 and 2007. In a total of 88 patients, 50 (57%) underwent non-surgical and 38 (43%) surgical management. Baseline demographic, radiological-, clinical-, and surgical-related variables were collected. An Oswestry Disability Index (ODI) 2.0 questionnaire was sent to all patients after written informed consent.ResultsTwenty-nine of 88 patients participated in the study, 15 (52%) had undergone surgical and 14 (48%) non-surgical management with a mean follow-up of 10.9 years (range 8–15 years). There were no significant differences (p > 0.05) between non-surgical and surgical patients at baseline for age, body mass index, coronal Cobb angle, and clinical data. None of the non-surgical patients had undergone surgery during follow-up. In the surgical group, 40% had revision surgery. There was no significant difference in ODI total scores between groups at final follow-up (p = 0.649). A larger proportion of patients in the non-surgical group reported an ODI total score of ≤ 22, reflecting minimal disability (43 versus 20%; p = 0.245).ConclusionsThis is the first study that describes the long-term 10-year functional outcome of non-surgical and surgical management in a cohort of patients with DNDLS. No significant difference in functional outcome was found between groups after a mean follow-up of 10 years. Despite the significant potential for selection bias, these results indicate that non-surgical management of patients with DNDLS may lead to adequate functional outcome after long periods of time, with no crossover to surgery. Further study is warranted to define which patients may benefit most from which management regimen.
Highlights
No studies have evaluated the long-term results of non-surgical and surgical management in de novo degenerative lumbar scoliosis (DNDLS)
There was no significant difference between the two groups with regards to age (p = 0.25), body mass index (BMI) (p = 0.79), Cobb angle (p = 0.37), and years of follow-up (p = 0.84)
Percentages are calculated from the total number of non-surgical (n = 14) and surgical (n = 15) patients. p values were calculated using Fisher’s Exact Test and leg pain, and pre-treatment neural comprise) in the present study is relatively comparable to previous studies demonstrating that surgical is superior to non-surgical management (Table 1), the results of the present study demonstrate that certain patients can benefit from non-surgical management for long periods of time (Table 4)
Summary
No studies have evaluated the long-term results of non-surgical and surgical management in de novo degenerative lumbar scoliosis (DNDLS). This study reports on the long-term functional outcome of patients being treated for DNDLS by non-surgical and surgical management. The prevalence of DNDLS in the low back pain population has been reported to be 15% [5], and 68% in asymptomatic adults over the age of 60 years [6]. In light of the aging population, the prevalence of DNDLS will continue to increase [7, 8]. For this reason, the identification of proper ways of management has gained in urgency. Surgical treatment for DNDLS is known to be associated with high complication and revision rates [13]
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