473 © Springer Nature Switzerland AG 2019 B. Meyer, M. Rauschmann (eds.), Spine Surgery, https://doi.org/10.1007/978-3-319-98875-7_57 Degenerative Lumbar Scoliosis Sebastian Hartmann, Anja Tschugg, and Claudius Thomé 57.1 Introduction Treatment strategies for degenerative lumbar sco- liosis (DLS) range from simple decompression of neural structures or decompression with limited fusion to invasive curve correction manoeuvres with extended fusion procedures [14]. In general, the literature demonstrates that the surgical treat- ment of DLS patients seems to be superior to conservative care. Nevertheless, a high rate of complications based on some neurological and predominately mechanical failures has been reported [4, 13, 15]. The scoliotic curve progresses in the ffth decade of life with a life time prevalence between 8% and 13%. Thus, the prevalence of DLS increases with age and patients in the sixth decade of life are predominantly affected [3, 5, 7, 8, 16, 17]. Therefore, the comorbidities of DLS patients associated with increased age aggravate the surgi- cal treatment with higher complication rates, especially in case of extensive correction manoeuvres. Approximately two-thirds of the patients suf- fer from an isolated and segmental coronal defor- mity, so that in many cases decompression with accompanied instrumented fusion seems to be suffcient. In case of additional sagittal defor- mity, the selection of the “appropriate” treatment strategy remains diffcult. The majority of DLS patients additionally demonstrate segmental kyphosis resulting in moderate or severe sagittal imbalance [5, 8, 16]. Consequently, a classifcation system of degenerative disc disease based on the distribu- tion of the degenerated symptomatic segments with regard to distinct areas of the main coronal curve (apical and end area) and the balance status of the spine has been generated to guide the treat- ment of DLS patients [2]. The apical area of the degenerative scoliotic curve was defned as the apex of the main curve, a vertebra or a disc level and the end area is proposed as the non-apical area adjacent to the end vertebra of the main lum- bar degenerative curve. Correspondingly, four types of degenerative disease in adults with lum- bar or thoracolumbar deformity were generated. This chapter will capture the essentials of degenerative lumbar scoliosis, the clinical pre- sentation, indications and surgical approaches, but will focus on more complex lesions with sag- ittal imbalance. Additionally, the clinical out- come as well as the potential complications are discussed. Pitfalls are outlined at the end of this chapter. The presented case will detail the following problems: S. Hartmann (*) · A. Tschugg · C. Thomé Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria e-mail: sebastian.hartmann@i-med.ac.at 57