Radiographs reveal multisegmental collapse, spondylosis, osteoporosis, and hypermobile segments. Spondylolisthesis may occur concurrently. A broad-based annular bulging should not be misinterpreted as a herniation of disk material. Nonoperative treatment of degenerative scoliosis is often met with failure. Bracing is ineffective in preventing progression and is poorly tolerated.20 Both decompression and fusion are most often indicated, although an occasional unilateral root decompression may be appropriate for patients with nerve root involvement at one or two levels and minimal back discomfort.
Back pain is less commonly an indication for surgery.
Preoperative studies should be correlated with clinical symptoms, and meticulous decompression should be done. Goldstein and Willham21 looked at the applicability of parameters used in adolescent scoliosis in choosing fusion levels. These included the center sacral line, stable zone, neutrally rotated vertebra, degenerative arthritis, displaced wedging, rotatory subluxation, and hemisacralization. No single measurement was of predictive value. The most important factors were the magnitude of degeneration and its extent into lower lumbar levels.