الفهرس 
): Anatomy and Biomechanics of Lumbar SpineOnly 14 pages are availabe for public view
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Abstract
Degenerative lumbar scoliosis is a coronal deviation of the spine that is prevalent in the elderly population. Although the etiology is unclear, it is associated with progressive and asymmetric degeneration of the disc, facet joints, and other structural spinal elements typically leading to neural element compression.
Clinical presentation varies and is frequently associated with axial back pain, neurogenic claudication, scoliosis and coronal and sagittal imbalance. The heterogeneous conditions may lend managing patients difficult.
Indications for treatment include pain, neurogenic symptoms, and progressive cosmetic deformity. Non-operative treatment includes physical conditioning and exercise, pharmacological agents for pain control, and use of orthotics and invasive modalities like epidural and facet injections.
There are three surgical options for adult degenerative scoliosis: Decompression alone; decompression and limited short fusion; and long fusion with correction of deformity. Decompression alone is not usually recommended due to curve progression after surgery. Limited short fusion is performed in decompressed segments. This procedure is indicated in cases with less Cobb angle, minimal rotational deformity and no coronal and sagittal imbalance. With this short fusion, correction of scoliosis and restoration of lumbar lordosis are not adequate; and therefore all segments of deformity should be included in the fusion to correct the deformity. This long fusion is indicated in cases of severe Cobb angle and coronal and sagittal imbalance.
The goal of surgery is not only to relieve pain and correct deformity, but also to minimize complications related to surgery, as the incidence of complications is relatively high. Limited short fusion is likely to cause proximal adjacent segment disease in the un-fused segments. Long fusion with correction of deformity causes more blood loss and high perioperative complications. Accordingly surgeons should attempt to seek a trade-off between the benefits of surgery and risks of complications. One should consider the patient’s general condition, not just that of the spine, when choosing surgical options.