Letter to the Editor: Analysis of Functional and Radiological Outcome Following Lumbar Decompression without Fusion in Patients with Degenerative Lumbar Scoliosis

Article information

Asian Spine J. 2020;14(4):586-587

Publication date (electronic) : 2020 July 22

doi : https://doi.org/10.31616/asj.2020.0060r1

Tarush Rustagi^,¹, Abhinandan Reddy ¹, Rajat Mahajan ¹, Kalidutta Das ¹, Harvinder Singh Chhabra ¹

Department of Spine Surgery, Indian Surgery, Injuries Centre, New Delhi, India

Corresponding Author: Tarush Rustagi Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi 110070, India Tel: +91-8826383706, +91-8826383705, Fax: +91-42255225, E-mail: tarush.rustagi@gmail.com

Received 2020 February 10; Accepted 2020 February 11.

Dear Editor,

We read with great interest the paper titled “Analysis of the functional and radiological outcomes of lumbar decompression without fusion in patients with degenerative lumbar scoliosis” by Gadiya et al. [1]. We compliment the authors for their work and providing us with good followup data. The authors further emphasize on the fact that all degenerative scoliosis with stenosis do not need instrumentation.

We would like to have authors opinion as to what were the surgical indications of offering decompression in cases of degenerative scoliosis with stenosis? They did mention, that they included cases of >10° of scoliosis. However, it was not clear if they preferred decompression irrespective of the degree of scoliosis or any another radiological finding.

Somehow, we feel that from the title of the study or the methods section, it is not clear to the readers as to what criterion they chose for their cases. Additionally, they conclude that decompression gives good outcome after surgery in degenerative scoliosis. Do they feel, it is true for all cases of degenerative scoliosis or they have any guidelines for the readers to follow?

Studies have reported certain radiological findings to determine spine stability in degenerative scoliosis with high risk of progression demanding fusion like coronal plane cobbs >30°, olisthesis, L3 obliquity, spondylolisthesis, lateral listhesis >6 mm, etc. [2-7]. Do the authors feel that these radiological findings help in decision making?

It would be interesting for the readers to know if any patients in their cohort had severe scoliosis or radiological signs of instability and how they did after decompression alone. There are numerous studies that have shown that decompression alone works for cases where the cobb angle is less than 30° [2,3,8]. The mean cobb angle of their cohort was 20.8° which indicated mild scoliosis and the authors reported good outcomes. Do the authors feel that their surgical indications criterion or method of decompression was any different?

Again, we compliment the authors for their commendable effort and record keeping. The readers would benefit from this study.

Notes

No potential conflict of interest relevant to this article was reported.

References

1. Gadiya AD, Borde MD, Kumar N, Patel PM, Nagad PB, Bhojraj SY. Analysis of the functional and radiological outcomes of lumbar decompression without fusion in patients with degenerative lumbar scoliosis. Asian Spine J 2020;14:9–16.

2. Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M. Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 2002;27:387–92.

3. Berven SH, Deviren V, Mitchell B, Wahba G, Hu SS, Bradford DS. Operative management of degenerative scoliosis: an evidence-based approach to surgical strategies based on clinical and radiographic outcomes. Neurosurg Clin N Am 2007;18:261–72.

4. Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 2007;7:428–36.

5. Benner B, Ehni G. Degenerative lumbar scoliosis. Spine (Phila Pa 1976) 1979;4:548–52.

6. Frazier DD, Lipson SJ, Fossel AH, Katz JN. Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine (Phila Pa 1976) 1997;22:2025–9.

7. Pritchett JW, Bortel DT. Degenerative symptomatic lumbar scoliosis. Spine (Phila Pa 1976) 1993;18:700–3.

8. Gupta MC. Degenerative scoliosis: options for surgical management. Orthop Clin North Am 2003;34:269–79.

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