About the Book

• The unique format of Adult Degenerative Scoliosis, featuring over 190 colour illustrations.
• Aids spine surgeons in the management of various degenerative spinal conditions.
• Consisting of three sections, the book provides an overview of lumbar degenerative scoliosis, indications for treatment and surgical planning and discussion on the available surgical techniques.
• Contains authoritative commentary on the experiences of leading surgeons.
• Guides surgeons’ choice of operative therapy.
• This book combines the expertise of both Orthopaedics and Neurosurgery specialists, providing insight into optimal treatment and patient outcomes.
• Expected to serve as a manual to readers of several disciplines on the difficult topic of degenerative scoliosis.

About the Author

James S Harrop MD Alexander R Vaccaro MD PhD Ahmed J Awad MD

Table of Contents:
Section 1: Lumbar Degenerative Scoliosis 1. Thoracolumbar Spine Anatomy and Pathoetiology of Degenerative Scoliosis 3 Shyam A Patel, Jeffrey A Rihn • Spinal Anatomy 3 • Thoracic and Lumbar Anatomy 4 • Demographics and Epidemiology 5 • Pathoetiology 5 • Initiation of Curvature 7 • Genetic Etiologies 9 2. Imaging and Radiographic Measurement Techniques for Lumbar Degenerative Scoliosis 12 Ahmed J Awad, Kenan Al-khalili, Christopher M Maulucci, Joshua E Heller, James S Harrop • Conventional Radiography 12 • Cobb Angle Technique 13 • Global Balance 15 • Rotatory Subluxation 15 • The SRS-Schwab Classification 16 • Advanced Imaging 18 3. The Importance of Spinal Alignment in the Management of Lumbar Degenerative Scoliosis 21 Marco Girolami, Shian Liu, Virgine Lafage, Frank J Schwab • Degenerative Scoliosis 21 • Pathology of DDS vs AISA 21 • Clinical Presentation 24 • Radiological Evaluation 26 • Treatment 29 4. Natural History of Non-operative Treatment for Lumbar Degenerative Scoliosis 33 Randall B Graham, Tyler R Koski • Radiographic Progression 33 • Clinical Progression 33 • Case Presentation 34 5. Clinical and Biomechanical Differences in the Treatment of Adult Degenerative and Idiopathic Scoliosis 37 Dennis S Meredith, Todd J Albert • Initial Presentation and Evaluation 38 • Goals of Treatment and Surgical Considerations 39 Section 2: Surgical Planning 6. When is Posterior Decompression alone Adequate in the Setting of Lumbar Degenerative Scoliosis? 45 Louis F Amorosa, Alan S Hilibrand • Case Presentation 46 • Discussion 47 7. Determining Fusion Levels in Lumbar Degenerative Scoliosis 55 Adam J Bevevino, Ronald A Lehman, Lawrence G Lenke • Clinical and Radiographic Evaluation 56 Contentsxviii Adult Degenerative Scoliosis—Coronal and Sagittal Deformities: Treatment and Management • Case Presentation 57 • The Distal Fusion Level 57 • The Proximal Fusion Level 60 • Complications 62 8. Is an Interbody Fusion Always Necessary? 64 Beejal Y Amin, Tarik Ibrahim, Rishi Wadhwa, Hai Le, Charles Eichler, Praveen Mummaneni • Case Presentation 64 • Discussion 65 • Types of Interbody Material 69 • Indications and Contraindications 70 • Things not to do and Complications 71 9. Lateral Lumbar Interbody Fusion for Treatment of Degenerative Scoliosis 75 Kasra Ahmadinia, Frank M Phillips • Case Report 76 • Discussion 76 • Complications 78 10. When Does One Stop at L5 as a Distal Fusion Level Instead of the Sacrum in Multilevel Fusions for Lumbar Degenerative Scoliosis? 81 Alp Yurter, Daniel M Sciubba • Case Presentation 81 • Discussion 84 • Choosing L5 as Site of Distal Fusion 85 • Complications 86 Section 3: Surgical Techniques 11. Anterior Approaches to the Lumbar Spine 93 Shay Bess, Bryan Kramer, Salvador A Brau • Indications for Anterior Column Support, and Outcomes Following Anterior Spinal Surgery for Adult Spinal Deformity 93 • Contraindications to Anterior Lumbar Approach 94 • Surgical Technique 96 • Clinical and Biomechanical Evaluation of ALIF vs TLIF 98 • Complications Associated with Anterior Lumbar Approaches 98 12. Posterior Fusion Techniques for Lumbar Degenerative Scoliosis 102 Christopher M Maulucci, Mark E Oppenlander, Joshua E Heller • Case Presentation 102 • Preoperative Workup 102 • Surgical Principles 103 • Bone and Bone Substitute Options 104 • Advantages of Posterior-Only Approach 104 • Disadvantages of Posterior-Only Approach 105 • Complications 105 13. Ponte Osteotomy 106 Anthony M Petrizzo, Jeffrey M Spivak • Case Presentation 107 • Surgical Technique 108 • Benefits of the Ponte Osteotomy 109 • Things Not To Do 109 • Complications 110Contents xix 14. Smith-Peterson Osteotomies 112 Robert F Heary, John C Quinn • Illustrative Case Presentation 115 • Complication Management 118 15. Pedicle Subtraction Osteotomy 121 John Paul Kelleher, Paul J Schmitt, Christopher P Ames, Christopher I Shaffrey, Justin S Smith • Case Presentation 123 • PSO Indications 123 • PSO Surgical Technique 124 • Complications 128 16. Vertebral Column Resection in Adult Degenerative Scoliosis 131 Han Jo Kim, Lawrence G Lenke • Case Presentation 131 • Surgical Technique 131 • Discussion 133 • Complications 134 17. The Lateral Approach 136 Rodrigo Amaral, Luis Marchi, Leonardo Oliveira, Luiz Pimenta • Case Presentation 136 • Surgical Principles 138 • Why Do It This Way 140 • Things Not To Do 141 • Complications and Management 141 18. Spino-pelvic Fixation Strategies in the Setting of Lumbar Degenerative Scoliosis 144 Carlo Bellabarba, Emiliano Vialle, Richard J Bransford • Case Presentation 144 • Discussion 146 • Why Do It This Way? 152 • What to Avoid 153 • Complications 153 19. Circumferential Approaches 156 Louis F Amorosa, Anita Mikkilineni, Alexander R Vaccaro • Case Presentation 156 • Surgical Principles (Goals) 158 • Why Do It This Way 161 • Things Not To Do 161 • Complications 162 20. Less Invasive Surgery for Adult Degenerative Scoliosis 166 Michael CL Suryo, Victor Popov, D Greg Anderson • Case Presentation 166 • Rationale for the Chosen Surgical Approach 168 • Drawbacks of the Chosen Approach 168 • Complications of the Approach 168 • Discussion 168 Index 171