degenerative scoliosis requires full deformity correction the argument against evan davies
TRANSCRIPT
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
