Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 74. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 724 Section Spinal Deformities and Malformations Decompression alone may result in curve compression The pros and cons of direct of indirect decompressions must be carefully weighed Decompression Procedure The type of decompression used depends on the extent of necessary decompression. There is the option to decompress microsurgically the lateral recess and or the foramen or to perform a more extensive canal enlargement by laminotomy hemilaminectomy or laminectomy to address the crucial compressive lesion. If two adjacent segments need to be decompressed a laminectomy can be considered specifically when a surgical stabilization is foreseen. Whether maintenance of the integrity of the vertebral arches is necessary in a stabilized and fused spine is not clear but it may prevent scarring of the dural sac. Besides the direct decompression as mentioned above there is the possibility of indirect decompression occurring on correction of deformity and realignment of the spine. The older the patient and the longer lasting the degenerative scoliosis is the more carefully this concept has to be applied. Adhesion of the dural sac due to scarring between the dura and the hypertrophied ligamentum flavum and facet joint capsules and sometimes directly to the bone may induce traction and or compression of neural elements with consecutive neurological deficit. The benefits of correction of the curve therefore have to be carefully weighed against the direct decompression. The idea that osteophytes and bony spurs may disappear over time in a stabilized and fused segment may leave the patient with sometimes persistent symptoms for quite a long time. The recommendation is to explore the crucial roots after a corrective measure by small fenestration of the spinal canal in order not to miss a possible persistent compression or traction of a neural element. Correction Procedures Sagittal balance Whether or not a degenerative scoliosis should be corrected remains a crucial is most .
