Combination of degenerative lumbar spinal stenosis and spinal deformity. Literature review

Abstract

The study objective is to analyze currently available publications on spinal deformity in patients with degenerative lumbar spinal stenosis.Materials and methods. We analyzed 90 manuscripts published between 1980 and 2017.Results. We describe the parameters used to assess spinal deformity and evaluate their role for predicting the course of degenerative spinal disease. We provide the results of latest studies assessing the impact of spinal deformity on the outcome of surgical treatment in patients with degenerative lumbar spinal stenosis. We identified the following risk factors for scoliosis progression: wedge-shaped intervertebral disc in the frontal projection, low middle sacral axis, lateral spondylolisthesis, small L vertebral body, vertebral rotation, Cobb angle >20°, and sagittal imbalance.Conclusion. We recommend decompressive interventions with facet joint preservation in patients with spinal deformity and degenerative lumbar spinal stenosis with no risk factors for scoliosis progression and radicular symptoms only (without pronounced low back pain). In patients with no risk factors for scoliosis progression, radicular symptoms, and low back pain, it is advisable to combine decompression with short fixation. For individuals at risk of scoliosis progression, we recommend supplementing decompression with long fixation exceeding scoliosis curve.