Degenerative scoliosis requires full deformity correction The argument against Evan Davies.

Degenerative scoliosis requires full deformity correction

The argument against

Evan Davies

2010

The French Conspiracy

• Complication rate 39%

• Risk Factors – No of levels– Fusion to sacrum– PSO

• 44% reoperation in 6 years

• Upper thoracic fusions

– More blood– 100% more complications– 400% higher pseudoarthrosis– 100% more revisions

NO DIFFERENCE IN ODISRS WORSE IN LONG FUSIONS

How do your patients look in clinic?

What are we treating?

– X-ray

– Back Pain

– Sagittal or coronal imbalance

– Neurogenic claudication/radiculopathy

• Cobb angle unchanged in decompression and limited fusion, 50% change in fusion

• Complications– Full fusion 56%– Partial fusion 40%– Decompression 10%

• SF-36/ODI significant improvement in decompression, limited fusion

• SF36/ODI no significant improvement in full fusion

The argument against

• It Costs More

• It Hurts More

• You do worse