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Prevalence, Severity, and Impact of Foraminal and Canal Stenosis Among Adults With Degenerative Scoliosis

Fu, Kai-Ming G. MD, PhD*; Rhagavan, Prashant MD; Shaffrey, Christopher I. MD§; Chernavvsky, Daniel R. MD§; Smith, Justin S. MD, PhD§

doi: 10.1227/NEU.0b013e31822a9aeb
Research-Human-Clinical Studies

BACKGROUND: Management approaches for adult scoliosis are primarily based on adults with idiopathic scoliosis and extrapolated to adults with degenerative scoliosis. However, the often substantially, but poorly defined, greater degenerative changes present in degenerative scoliosis impact the management of these patients.

OBJECTIVE: To assess the prevalence, severity, and impact of canal and foraminal stenosis in adults with degenerative scoliosis seeking operative treatment.

METHODS: A prospectively collected database of adult patients with deformity was reviewed for consecutive patients with degenerative scoliosis seeking surgical treatment, without prior corrective surgery. Patients completed the Oswestry Disability Index, SF-12, Scoliosis Research Society 22 questionnaire, and a pain numeric rating scale (0-10). Based on MRI or CT myelogram, the central canal and foraminae from T6 to S1 were graded for stenosis (normal or minimal/mild/moderate/severe).

RESULTS: Thirty-six patients were included (mean age, 68.9 years; range, 51-85). The mean leg pain numeric rating scale was 6.5, and the mean Oswestry Disability Index score was 53.2. At least 1 level of severe foraminal stenosis was identified in 97% of patients; 83% had maximum foraminal stenosis in the curve concavity. All but 1 patient reported significant radicular pain, including 78% with discrete and 19% with multiple radiculopathies. Of those with discrete radiculopathies, 76% had pain corresponding to areas of the most severe foraminal stenosis, and 24% had pain corresponding to areas of moderate stenosis.

CONCLUSION: Significant foraminal stenosis was prevalent in patients with degenerative scoliosis, and the distribution of leg pain corresponded to levels of moderate or severe foraminal stenosis. Failure to address symptomatic foraminal stenosis when surgically treating adult degenerative scoliosis may negatively impact clinical outcomes.

*Department of Neurosurgery, Weill Cornell Medical College, New York, New York

Department of Radiology, University of Virginia, Charlottesville, Virginia

§Department of Neurosurgery, University of Virginia, Charlottesville, Virginia

Correspondence: Justin S. Smith, MD, PhD, University of Virginia Health Sciences Center, Department of Neurosurgery, PO Box 800212, Charlottesville, VA 22908. E-mail:

Received September 3, 2010

Accepted March 31, 2011

Copyright © by the Congress of Neurological Surgeons