Precision Treatment of Adult Lumbar Degenerative Scoliosis Complicated by Lumbar Stenosis with the Use of Selective Nerve Root Block

BACKGROUND: Use of short-segment or long-segment fusion is controversial in treatment of adult lumbar degenerative scoliosis (ALDS). The aim of this study was to explore efficacy and feasibility of precision treatment of ALDS with selective nerve root block. METHODS: From January 2014 to January 2016, a retrospective study of 23 patients with ALDS treated with precision short-segment surgery with at least 2-year follow-up was performed. Fixation segment was determined by selective nerve root block. Visual analog scale and Oswestry Disability Index (ODI) were evaluated preoperatively and at 2-year follow-up. Radiographic measurements included Cobb angle of lumbar curve, lumbar lordosis, sacrum slope, and pelvic tilt. Radiographic evaluation of fusion integrity was performed based on Bridwell interbody fusion grading system at final follow-up. RESULTS: Mean follow-up time was 25.2 +/- 1.4 months. Average lumbar curve was 21.6 degrees +/- 7.4 degrees preoperatively and 11.2 degrees +/- 6.5 degrees at final follow-up (P < 0.01), with correction rate of 48.1%. Lumbar lordosis changed from -37.1 degrees +/- 12.9 degrees to -42.1 degrees +/- 10.5 degrees at final follow-up (P< 0.01). Mean visual analog scale back pain scores decreased from 6.0 +/- 1.8 preoperatively to 1.5 +/- 0.8 at final follow-up (P < 0.01), and mean visual analog scale leg pain scores decreased from 8.1 +/- 0.6 preoperatively to 1.3 +/- 1.3 at final follow-up (P < 0.01). Oswestry Disability Index score improved from 60.9% +/- 15.7% preoperatively to 22.1% +/- 11.6% at final follow-up (P < 0.01). All patients achieved grade I fusion at final evaluation. One patient (4%) needed further surgical intervention. CONCLUSIONS: Precision treatment of ALDS with selective nerve root block can achieve favorable clinical outcomes and good fusion with less surgical injury and low complications. Deformity correction is limited, which requires further study.