Degenerative scoliosis of the spine: diagnosis, classification and surgical approach in older patients

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Abstract

Adult scoliosis is a deformity of the spine with an angle of more than 10° (according to Cobb) in people with a fully formed bone system. Due to the aging of the population, improvement of surgical techniques, creation of new implants and progress in anesthetic aids, the problem of degenerative scoliosis has been more and more frequently considered from the viewpoint of a surgical approach. There are many theories about the factors that contribute to the formation of degenerative scoliosis. The conservative therapy of degenerative scoliosis includes non-steroidal anti-inflammatory drugs, bracing, epidural and paravertebral injections with glucocorticosteroids and physical therapy. In case the conservative therapy is ineffective and there is a significant decrease in the quality of life, the issue of the surgical intervention is raised individually for each patient. Currently, the role and the volume of the surgical intervention in individuals with this pathology remains debatable. The choice of a surgical technique depends on a thorough assessment of clinical symptoms, neurological status, data of instrumental methods and a mandatory estimation of the parameters of the global vertebral-pelvic balance. Therefore, in this article, we pay special attention to the surgical algorithms based on the choice of the decompression type and the fusion length. We describe the generally accepted criteria for selecting the level of spondylosynthesis. Special attention is paid to the risk factors of the surgical treatment, as well as associated complications.

About the authors

Anton V. Yarikov

Privolzhsky District Medical Center; City Clinical Hospital No. 39

Email: anton-yarikov@mail.ru
ORCID iD: 0000-0002-4437-4480
SPIN-code: 8151-2292

MD, Cand. Sci. (Med.)

Russian Federation, 2, nab. Nizhne-Volzhskaya, 603001, Nizhny Novgorod; Nizhny Novgorod

Anton A. Denisov

Vreden National Medical Center for Traumatology and Orthopedics

Email: denisov1993@gmail.com
ORCID iD: 0000-0002-9178-8715
SPIN-code: 7505-7491
Russian Federation, Saint Petersburg

Igor I. Smirnov

City Clinical Hospital No. 39

Email: igorev_19931993@mail.ru
ORCID iD: 0000-0002-1766-9515
SPIN-code: 6390-0872
Russian Federation, Nizhny Novgorod

Alexandr A. Kalinkin

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: aleksandr_kalinkin27@mail.ru
ORCID iD: 0000-0003-0720-4850
SPIN-code: 9919-5834

 MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Denis N. Dolotin

Novosibirsk Research Institute of Traumatology & Orthopedics

Email: d.dolotin@mail.ru
ORCID iD: 0000-0003-0430-6595
SPIN-code: 1716-6880
Russian Federation, Novosibirsk

Sergey V. Masevnin

Vreden National Medical Center for Traumatology and Orthopedics

Email: drmasevnin@gmail.com
ORCID iD: 0000-0002-3879-4550
SPIN-code: 5505-2641

MD; Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Michail Y. Dokish

Vreden National Medical Center for Traumatology and Orthopedics

Email: dokish@mail.ru
ORCID iD: 0000-0002-9191-1787

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Olga A. Perlmutter

City Clinical Hospital No. 39

Email: oaperlmutter@mail.ru
ORCID iD: 0000-0003-2894-4110
SPIN-code: 1243-9601

MD, Dr. Sci. (Med.), Professor

Russian Federation, Nizhny Novgorod

Andrey G. Sosnin

Privolzhsky District Medical Center

Email: sosdoc@yandex.ru
ORCID iD: 0000-0001-7912-3756
SPIN-code: 6493-2303

MD, Cand. Sci. (Med.)

Russian Federation, 2, nab. Nizhne-Volzhskaya, 603001, Nizhny Novgorod

Alexandr P. Fraerman

City Clinical Hospital No. 39

Email: operacii39@mail.ru
ORCID iD: 0000-0002-2221-2042
SPIN-code: 2974-3349

MD, Dr. Sci. (Med.), Professor

Russian Federation, Nizhny Novgorod

Alexandr E. Simonov

City Clinical Hospital No. 39

Email: asimo@ya.ru
ORCID iD: 0000-0001-7892-4893
SPIN-code: 7575-5957

MD, Cand. Sci. (Med.)

Russian Federation, Nizhny Novgorod

Ekaterina V. Sannikova

Vreden National Medical Center for Traumatology and Orthopedics

Author for correspondence.
Email: sannikovaekaterina@rambler.ru
ORCID iD: 0000-0002-9171-1697

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Microsurgical decompression in ADS (photo by A.E. Simonov).

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3. Fig. 2. Extended fixation and correction in ADS (photo by M.Y. Dokish).

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4. Fig. 3. Individual cages for spinal fusion, manufactured by 3D printing (photo by A.A. Denisov).

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5. Fig. 4. Spondylography of an ADS patient's spine before the surgery.

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6. Fig. 5. Spondylography of the same ADS patient. Extended transpedicular fixation and anterior spinal fusion are performed with the use of individual implants.

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Copyright (c) 2021 Yarikov A.V., Denisov A.A., Smirnov I.I., Kalinkin A.A., Dolotin D.N., Masevnin S.V., Dokish M.Y., Perlmutter O.A., Sosnin A.G., Fraerman A.P., Simonov A.E., Sannikova E.V.

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