Case Report: Conservative Management of Degenerative Thoracolumbar Scoliosis with Vertebral Compression Fractures in an Elderly Patient

Abstract

Background: Elderly patients with degenerative thoracolumbar scoliosis face difficult care issues, especially if they have spinal stenosis and vertebral compression fractures. Conservative care is still the primary strategy for older patients with stable neurological condition and substantial surgical risk factors, even if surgical intervention is frequently recommended for symptomatic spinal abnormalities.

Case Presentation: We describe the case of an 88-year-old man who has had increasing lower back discomfort for the past three years due to bilateral spinal compression fractures (D10, D11, and burst fracture of D12), multilevel disc desiccation, and thoracolumbar scoliosis. The patient had intact neurological function (normal motor strength 5/5, preserved sensory function, and normal deep tendon reflexes) despite severe spinal canal stenosis with anterior thecal sac depression and bilateral neural foramina constriction on MRI. A thorough conservative treatment that included neuroprotective supplements (methylcobalamin, alpha-lipoic acid, and benfotiamine), multimodal physiotherapy, nutritional optimization, and pharmaceutical pain management with NSAIDs and antihypertensive medication was helpful in managing the patient.

Results: The patient showed notable symptom relief, preserved neurological integrity, and improved functional mobility following five days of hospital care and ongoing outpatient conservative therapy. At the one-month follow-up, the patient was able to manage their discomfort, move around freely, and maintain their quality of life without the need for surgery.

Conclusion: When neurological function is maintained, this case demonstrates the efficacy of properly chosen, multimodal conservative treatment for older individuals with degenerative thoracolumbar scoliosis and spinal compression fractures. While avoiding the significant perioperative risks associated with spine surgery in advanced age, comprehensive physiotherapy, neuroprotective supplements, nutritional optimization, and constant neurological monitoring yield good results.