Lumbar (Degenerative) Scoliosis: Complication in Anterior/Posterior Surgery

Adult degenerative lumbar scoliosis is a three-dimensional deformity and can lead to diminished health-related quality of life. Typically patients present with stooped forward gait and back pain with or without radicular leg pain. If conservative treatment has failed, there are various surgical treatment options with good clinical results but high risk of complications. We present the case of a 67-year-old male with degenerative lumbar kyphoscoliosis treated with a combined anterior-posterior two-stage surgery. The first stage involved a lateral interbody fusion L1–L5 from a right trans-psoas approach, and the second stage was an instrumented fusion from T10 to the pelvis with left-sided L5–S1 transforaminal interbody fusion. During the second stage, his motor-evoked potentials showed a bilateral drop in the vastus medialis. Despite taking multiple measures intra- and postoperatively, he developed a delayed neurological deficit. Neurological complications of different approaches are compared and discussed. Potential options and algorithm to treat the complication were elaborated. Despite careful attention to all these measures, the risk of neurological deficit remains significant.