Symptomatic progression of degenerative scoliosis after decompression and limited fusion surgery for lumbar spinal stenosis

Significant degenerative scoliosis together with lumbar spinal stenosis increases the complexity of planning a surgical intervention for iatrogenic instability may be introduced by decompression in the midst of the curve, especially at or near the curve apex, that may lead to more rapid progression of a deformity, especially if surgery is at, or is near, the apex of the curve and a listhesis is present. Surgical options include simple laminectomy, a laminectomy with limited fusion, or an extensive fusion that addresses the overall curve, but there is no consensus as to the best approach. There is scant information in the literature about specific instances of failure of a limited surgical approach from which any instructive lessons may be learned. We report a surgical failure in a 59-year-old woman with degenerative lumbar stenosis and scoliosis from L3-5 and L3-4 disc herniation treated with a simple hemilaminectomy and discectomy, a subsequent fusion for symptomatic progression of deformity, and a third surgery to fuse the entire scoliotic curve after development of severe deformity, pain, and neurological deficits. We conclude that surgical decision-making should take into consideration any risk factors for deformity progression as well as overall sagittal and coronal balance and advise that similar patients be followed for a lengthy period following surgery to monitor for stability. (C) 2012 Elsevier Ltd. All rights reserved.