Degenerative lumbar scoliosis (DLS) is associated with the focal development of coronal deformity due to degenerative changes in the mid portion of the lumbar spine. These degenerative changes are multifactorial and range from intervertebral disc degeneration and facet joint degeneration to changes in canal as well as pedicle morphology. The scoliotic curve typically progresses in the fifth decade of life with a life time prevalence of approximately 10% increasing with age. Especially older patients suffer from long curves with coronal deformity as well as abnormalities of sagittal spinopelvic parameters. Treatment strategies according to the approach (anterior, posterior, combined) as well as clear and formalized recommendations of short or long instrumentation techniques are lacking. Although single-level decompression procedures might be feasible in patients with predominantly claudicative symptoms, many patients develop multisegmental disease with long sagittally and coronally decompensated curves, so that simple decompression procedures may be expanded to “heavy metal” solutions. It is currently unclear, whether long fusion techniques with anterior, posterior or combined techniques are superior to short fusions. Due the associated complication rate, however, short fusion techniques might be favoured over long constructs, especially in older patients with comorbidities and an increased perioperative risk. Additionally, there is still an on-going discussion based on the distal fusion level for degenerative lumbar scoliosis. The question remains, whether the segment L5/S1 should be included in the construct or not, especially in the absence of disc degeneration at that level. This chapter will capture the treatment of degenerative lumbar scoliosis based on using short or long fusion constructs. Additionally, clinical outcome as well as potential complications associated with these two treatment strategies are discussed. Pitfalls are outlined at the end of the chapter.
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