J Med Assoc Thai Vol. 93 No. 4 2010 457 The Results of Decompression and Instrumented Fusion with Pedicular Screw Plate System in Degenerative Lumbar Scoliosis Patients with Spinal Stenosis: A Prospective Observational Study Gun Keorochana MD*, Tulyapruek Tawonsawatruk MD*, Wichien Laohachareonsombat MD*, Wiwat Wajanavisit MD*, Suphaneewan Jaovisidha MD** * Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Objective: To study pain relief, curve correction, and functional outcomes after decompression and instrumented arthrodesis in degenerative lumbar scoliosis patients with spinal stenosis. Material and Method: Thirty-one degenerative scoliosis patients with symptom of spinal stenosis who underwent decompression and fusion with pedicular screw plate instrumentation and completed at least 2-year follow-up were included in this study. Functional outcomes were obtained using Oswestry Disability Index (ODI) and Roland Morris score. The VAS pain relief, walking ability, and curve correction were collected as a result of the surgery. Results: Average age of the patients at the time of surgery was 64.87 years (range, 50-87 years) and mean follow-up was 32 months (range, 24-60 months). There was significant improvement in all outcome parameters including pain scales, walking ability, ODI, and Roland Morris score (p < 0.05) Five patients had major complications with two cases requiring re-operation. Conclusion: Degenerative scoliosis with spinal stenosis is a complex spinal disease that requires decompression and stabilization procedures. Wide decompressive laminectomy and instrumented arthrodesis with pedicular screw plate system provided satisfied outcome included pain relief and functional restoration. Keywords: Degenerative scoliosis, Spinal stenosis, Surgery, Arthrodesis, Instrumentation, Outcome Correspondence to: Keorochana G, Department of Ortho- paedics, Faculty of Medicine, Ramathibodi Hospital, 270 Rama VI Rd, Rajthevee, Bangkok 10400, Thailand. Phone: 0-2201-1589, 0-2201-1599, Fax: 0-2201-1599. E-mail: gun_keo@yahoo.com Degenerative (de novo) scoliosis is defined as any frontal plane curvature of the spine more than 10 degrees that developed without a previous history of scoliosis in a childhood period (1) . It should be distinguished from adult idiopathic scoliosis that is the consequence of a process beginning before skeletal maturity, even though it may not always be possible to exactly discriminate degenerative from adult idiopathic scoliosis (2) . Degenerative lumbar scoliosis developed on asymmetric degenerative change of the disc with the consecutive frontal plane deviation and a concomitant curve rotation. Patients with degenerative lumbar scoliosis usually present with disabling low back pain and/or lower extremities pain and/or spinal imbalance (3) . Surgical treatment in degenerative lumbar scoliosis is much more complicated than lumbar spinal stenosis due to senility, osteoporosis, more medical co-morbidities, and more aggressive procedures in these patients (4) . Thus, the surgery is reserved when comprehensive aggressive conservative treatment failed. Although many literatures reported the favorite outcome after surgery in lumbar spinal stenosis, the degenerative scoliosis patients were usually in the subgroup analysis of those studies (5-9) . The other published series reported the results of surgery in J Med Assoc Thai 2010; 93 (4): 457-61 Full text. e-Journal: http://www.mat.or.th/journal