Our Summary

This research study aimed to determine when surgical intervention is appropriate for patients with degenerative lumbar scoliosis (DLS), a condition that affects the spine as people age. The researchers gathered a team of 11 experts from various medical fields and reviewed existing studies on this topic. They then used a method known as the Delphi process to assess the appropriateness of five different surgical procedures across 260 different patient scenarios. These scenarios considered factors such as the patient’s age, other medical conditions, symptoms, and the severity of their DLS.

The review of existing studies showed that most of the research on this topic is either small in scale or uses weak research designs. The expert panel concluded that surgery is generally appropriate for patients with severe symptoms and larger or worsening spinal deformities. It’s also suitable for patients with moderate spinal narrowing or imbalances in the alignment of their spine. On the other hand, surgery is usually not considered appropriate for patients with mild symptoms and smaller, stable spinal deformities, especially if they are older and have multiple other health conditions. For patients with large or worsening deformities, or severe spinal narrowing, the experts generally preferred more extensive surgery.

This research could help doctors make more evidence-based decisions about when to recommend surgery for patients with DLS, improving the consistency and quality of care for these patients.

FAQs

  1. What was the purpose of this research study on degenerative lumbar scoliosis (DLS)?
  2. What factors did the researchers consider when determining the appropriateness of surgical intervention for DLS patients?
  3. What conclusions did the expert panel reach regarding surgical intervention for patients with DLS?

Doctor’s Tip

One helpful tip a doctor might tell a patient about scoliosis surgery is to carefully follow their post-operative care instructions to ensure proper healing and recovery. This may include restrictions on certain activities, physical therapy exercises, and regular follow-up appointments with their healthcare provider. By taking these steps, patients can optimize their outcomes and minimize the risk of complications.

Suitable For

Overall, patients who are typically recommended for scoliosis surgery are those with severe symptoms, larger or worsening spinal deformities, moderate spinal narrowing or imbalances in the alignment of their spine. Surgery is generally not recommended for patients with mild symptoms, smaller, stable spinal deformities, older age, and multiple other health conditions. The decision to undergo surgery should be made on a case-by-case basis, taking into account the individual patient’s symptoms, spinal deformity, age, and overall health status.

Timeline

Timeline of patient experience before and after scoliosis surgery:

Before surgery:

  1. Patient is diagnosed with scoliosis through physical examination, imaging tests such as X-rays or MRI, and assessment of symptoms.
  2. Patient undergoes conservative treatments such as physical therapy, bracing, and pain management to manage symptoms and slow the progression of the curve.
  3. Patient and their healthcare team monitor the progression of the curve through regular follow-up appointments and imaging tests.

After surgery:

  1. Patient undergoes pre-operative assessments such as blood tests, ECG, and chest X-ray to ensure they are healthy enough for surgery.
  2. Patient meets with the surgical team to discuss the procedure, risks, benefits, and post-operative expectations.
  3. Patient undergoes scoliosis surgery, which can involve spinal fusion, instrumentation, and correction of the curve.
  4. Patient stays in the hospital for a few days to recover and receive post-operative care.
  5. Patient undergoes physical therapy to regain strength, mobility, and function.
  6. Patient follows up with their surgeon for regular appointments to monitor healing, manage pain, and address any complications.
  7. Patient gradually returns to normal activities, with full recovery typically taking several months to a year.

What to Ask Your Doctor

Some questions a patient should ask their doctor about scoliosis surgery include:

  1. What are the potential risks and complications associated with scoliosis surgery?
  2. What is the success rate of scoliosis surgery in terms of improving spinal deformity and relieving symptoms?
  3. What is the recovery process like after scoliosis surgery, and how long will it take to fully recover?
  4. Are there alternative treatment options to consider before opting for surgery?
  5. How will scoliosis surgery affect my daily activities, mobility, and quality of life?
  6. What type of surgical procedure is recommended for my specific case of scoliosis, and why?
  7. How experienced is the surgical team in performing scoliosis surgery, and what is their success rate?
  8. Will I need physical therapy or other forms of rehabilitation after scoliosis surgery?
  9. What are the long-term outcomes and potential complications I should be aware of after scoliosis surgery?
  10. How will scoliosis surgery impact my overall health and well-being in the future?

Reference

Authors: Chen PG, Daubs MD, Berven S, Raaen LB, Anderson AT, Asch SM, Nuckols TK; Degenerative Lumbar Scoliosis Appropriateness Group. Journal: Spine (Phila Pa 1976). 2016 May;41(10):910-8. doi: 10.1097/BRS.0000000000001392. PMID: 26679874