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 ODI SRS 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/radiculopat hy

Cobb angle unchanged in decompression and limited fusion, 50% change in fusion Complications – Full fusion 56% – Partial fusion40% – Decompression10%

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