There is ongoing controversy regarding the most appropriate surgical treatment for lumbar
spinal stenosis (LSS) with concurrent degenerative lumbar
scoliosis (DLS):
decompression alone,
decompression with limited
spinal fusion, or long
spinal fusion for
deformity correction. The coexistence of degenerative
stenosis and
deformity is a common scenario; Nonetheless, selecting the appropriate surgical intervention requires thorough understanding of the patients clinical symptomatology as well as radiographic parameters. Minimally invasive (MIS)
decompression surgery was performed for LSS patients with DLS. The aims of this study were (1) to investigate the clinical outcomes of MIS
decompression surgery in LSS patients with DLS, and (2) to identify the predictive factors for both radiographic and clinical outcomes after MIS surgery. 438 consecutive patients were enrolled in this study. Inclusion criteria was evidence of LSS and DLS with coronal curvature measuring greater than 10°. The Japanese Orthopaedic Association (JOA) score, JOA recovery rate,
low back pain (LBP), and radiographic features were evaluated preoperatively and at over 2 years postoperatively. Of the 438 patients, 122 were included in final analysis, with a mean follow-up of 2.4 years. The JOA recovery rate was 47.6%. LBP was significantly improved at final follow-up. Cobb angle was maintained for 2 years postoperatively (p = 0.159). Clinical outcomes in foraminal
stenosis patients were significantly related to sex, preoperative high Cobb angle and progression of
scoliosis (p = 0.008). In the severe
scoliosis patients, the JOA recovery was 44%, and was significantly depended on progression of
scoliosis (Cobb angle: preoperation 29.6°, 2-years follow-up 36.9°) and mismatch between the pelvic incidence (PI) and the lumbar
lordosis (LL) (preoperative PI-LL 35.5 ± 21.2°) (p = 0.028). This study investigated clinical outcomes of MIS
decompression surgery in LSS patients with DLS. The predictive risk factors of clinical outcomes were severe
scoliosis, foramina
stenosis, progressive
scoliosis and large mismatch of PI-LL.