Decompression in Adult Lumbar Deformity Surgery Is Associated With Increased Perioperative Complications but Favorable Long-Term Outcomes

Abstract

Study Design: Retrospective cohort study. Objectives: To analyze the impact of performing a formal decompression in patients with adult lumbar scoliosis with symptomatic spinal stenosis on perioperative complications and long-term outcomes. Methods: Adult patients undergoing at least 5 levels of fusion to the sacrum with iliac fixation from 2002 to 2008 who had a minimum 5-year follow-up at one institution were studied. Patients who had 3-column osteotomy were excluded from the study. Perioperative complications and clinical outcomes (Scoliosis Research Society [SRS], Oswestry Disability Index [ODI], and Numerical Rating Scale [NRS] back/leg pain) were analyzed. Patients who underwent formal laminectomy/decompressions were compared with those who did not. Differences between the 2 groups were analyzed using Student’s t test. Results: A total of 147 patients were included in the study (Decompression: n = 55 [37%], No decompression: n = 92 [63%]). Average fusion levels for the decompression and no decompression groups were 11 and 12 levels, respectively (P =.26). Mean improvements in SRS domains for decompression versus no decompression patients, respectively, were pain (1.1 vs 0.9, P =.3), function (0.7 vs 0.5, P =.09), self-image (1.1 vs 1.1, P =.9), and mental health (0.5 vs 0.4, P =.5). Furthermore, additional mean improvements were ODI (21 vs 21, P =.14), NRS-Back pain (3.0 vs 1.3, P =.16), and NRS-Leg pain (3.9 vs 0.5, P =.002). Complication rates between the decompression group and no decompression group differed in incidental durotomies (18.2% vs 0%) and cardiac-related (9.1% vs 1.1%). Conclusions: Performing a formal decompression in adult lumbar scoliosis with symptomatic spinal stenosis is associated with increased perioperative complications but favorable long-term clinical outcomes.