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H. Roy Silvers, P. Jeffrey Lewis and Harold L. Asch

-Willis WH , Paine KWE , Cauchoix J , et al : Lumbar spinal stenosis. Clin Orthop 99 : 30 – 50 , 1974 Kirkaldy-Willis WH, Paine KWE, Cauchoix J, et al: Lumbar spinal stenosis. Clin Orthop 99: 30–50, 1974 21. Kostuik JP : Recent advances in the treatment of painful adult scoliosis. Clin Orthop 147 : 238 – 252 , 1986 Kostuik JP: Recent advances in the treatment of painful adult scoliosis. Clin Orthop 147: 238–252, 1986 22. Kostuik JP , Errico TJ , Gleason TF : Techniques

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Paul W. Detwiler, Frederick F. Marciano, Randall W. Porter and Volker K. H. Sonntag

Although the efficacy of posterior decompression for symptomatic lumbar stenosis that is recalcitrant to conservative therapy is well proven, uniform agreement on the need for simultaneous arthrodesis is lacking. The variability in the rate of lumbar fusion with and without instrumentation has been attributed to a number of factors: advances in surgical technique; rapid development of instrumentation; radiographic advances in the diagnosis of disease entities of the lumbar spine; evolution in our understanding of bone healing; improved pre- and postoperative care; aggressive rehabilitation; patient compensation; hospital and surgeon reimbursement; better education of residents, fellows, and practicing neurosurgeons; and, most important, the lack of clear indications based on defined diagnostic categories. Based on review of the literature and their experience at the Barrow Neurological Institute, the authors have attempted to define indications for lumbar fusion with or without instrumentation based on defined diagnostic categories. Clear indications for fusion include trauma, tumor, or infection with two- or three-column injury, iatrogenic instability, and isthmic spondylolisthesis. Relative indications for fusion include degenerative spondylolisthesis, radiographically proven dynamic instability with pain or neurological findings, adult scoliosis, and mechanical back pain. Fusion is rarely indicated with discectomy, abnormal radiographs without appropriate findings (such as degenerative disc disease), facet joint syndrome, failed back surgery, or stable spinal stenosis.

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Olumide A. Danisa, Dennis Turner and William J. Richardson

and Cotrel-Dubousset instrumentation in the treatment of idiopathic lumbar and thoracolumbar scoliosis. Spine 19 : 19 – 429 , 1994 Suk SI, Lee CK, Chung SS. Comparison of Zielke ventral derotation system and Cotrel-Dubousset instrumentation in the treatment of idiopathic lumbar and thoracolumbar scoliosis. Spine 19: 19–429, 1994 29. Swank S , Lonstein JE , Moe JH , et al : Surgical treatment of adult scoliosis. A review of two hundred and twenty two cases. J Bone Joint Surg (Am) 63 : 268 – 287 , 1981

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Caleb R. Lippman, Caple A. Spence, A. Samy Youssef and David W. Cahill

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° to 14.7°. 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.

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.14.1.3 Pediatric spinal deformities Gregory C. Wiggins Christopher I. Shaffrey Mark F. Abel Arnold H. Menezes 1 2003 14 1 1 14 10.3171/foc.2003.14.1.4 FOC.2003.14.1.4 Thoracolumbar spinal deformity in achondroplasia Sanjay N. Misra Howard W. Morgan 1 2003 14 1 1 8 10.3171/foc.2003.14.1.5 FOC.2003.14.1.5 Correction of adult scoliosis via a posterior-only approach Caleb R. Lippman Caple A. Spence A. Samy Youssef David W. Cahill 1 2003 14 1 1 6 10.3171/foc.2003.14.1.6 FOC.2003.14.1.6 Pathogenesis, presentation, and treatment of lumbar spinal stenosis associated with

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Kazuhiro Hasegawa and Takao Homma

Goldstein JA, Macenski MJ, Griffith SL, et al: Lumbar sagittal alignment after fusion with a threaded interbody cage. Spine 26: 1137–1142, 2001 9. Grubb SA , Lipscomb HJ : Diagnostic findings in painful adult scoliosis. Spine 17 : 518 – 527 , 1992 Grubb SA, Lipscomb HJ: Diagnostic findings in painful adult scoliosis. Spine 17: 518–527, 1992 10. Grubb SA , Lipscomb HJ , Coonrad RW : Degenerative adult onset scoliosis. Spine 13 : 241 – 245 , 1988 Grubb SA, Lipscomb HJ, Coonrad RW

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Evaluation and treatment of adult spinal deformity

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Robert F. Heary

deformity surgery. 6, 38 In reality, for coronal-plane curves less than 90°, pulmonary compromise rarely develops as a result of spinal deformity. Pehrsson, et al., 32 performed a 20-year follow-up study of lung function in adult patients with idiopathic scoliosis. They found that there was no difference in pulmonary function in untreated adult scoliosis patients compared with normal changes due to the aging process alone. Operative Considerations Operative positioning is an important factor in successful surgery. For prone positioning, it is essential that the

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Benson P. Yang, Stephen L. Ondra, Larry A. Chen, Hee Soo Jung, Tyler R. Koski and Sean A. Salehi

75 : 449 – 455 , 2004 12 Farcy JP , Schwab FJ : Management of flatback and related kyphotic decompensation syndromes . Spine 22 : 2452 – 2457 , 1997 13 Glassman SD , Berven S , Bridwell K , Horton W , Dimar JR : Correlation of radiographic parameters and clinical symptoms in adult scoliosis . Spine 30 : 682 – 688 , 2005 14 Itoi E : Roentgenographic analysis of posture in spinal osteoporotics . Spine 16 : 750 – 756 , 1991 15 Kim KT , Suk KS , Cho YJ , Hong GP , Park BJ : Clinical outcome results of pedicle

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Peter D. Angevine and Paul C. McCormick

examined this relationship in patients with spinal deformity and degenerative disease. A critical analysis of these papers may help the spine surgeon to evaluate the clinical importance of a deviation of either overall sagittal balance or segmental alignment from normative population data. Glassman et al. 2 have reported the results of a prospective multicenter observational study of 298 patients with adult scoliosis. Their key conclusion was that “Positive sagittal balance predicts clinical symptoms in adult spinal deformity.” Although there are some data in that

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Atsushi Ono, Futoshi Suetsuna, Kazumasa Ueyama, Toru Yokoyama, Shuichi Aburakawa, Takuya Numasawa, Kanichiro Wada and Satoshi Toh

malformation presenting in adults: a surgical experience in 127 cases . Neurosurgery 12 : 377 – 390 , 1983 13 Milhorat TH , Johnson WD , Miller JI : Syrinx shunt to posterior fossa cisterns (syringocisternostomy) for bypassing obstructions of upper cervical theca . J Neurosurg 77 : 871 – 874 , 1992 14 Ono A , Ueyama K , Okada A , Echigoya N , Yokoyama T , Harata S : Adult scoliosis in syringomyelia associated with Chiari I malformation . Spine 27 : E23 – E28 , 2002 15 Peerless SJ , Durward QJ : Management of syringomyelia: a