Extension to the sacrum of previous adolescent scoliosis fusions in adult life

Numerous reports have indicated an increased risk for the development of pr ecocious degenerative changes leading to pain in patients who had fusions d one in adolescence for scoliosis, which extended into the lower lumbar spin e. The anatomic situation may lead to instability, or spinal stenosis or bo th. This paper represents the evolving experience in reconstructive surgery for patients in whom a fusion was to be extended to the sacrum, Reconstruc tive surgery will require, if necessary, decompression posteriorly for spin al stenosis if present. Stabilization is acquired through an anterior and p osterior approach with anterior and posterior instrumentation. The evolutio n of treatment modalities since 1976 shows a decreased pseudarthrosis rate from an initial 83% to 3% at present.