De novo degenerative lumbar scoliosis: a systematic review of prognostic factors for curve progression

Abstract

Purpose To identify prognostic factors for curve progression in de novo degenerative lumbar scoliosis (DNDLS) by performing a systematic review of the literature. Methods Studies were selected for inclusion following a systematic search in the bibliographic databases PubMed and EMBASE prior to September 2015 and hand searches of the reference lists of retrieved articles. Two authors independently assessed methodological quality. Data were extracted and presented according to a best evidence synthesis. Results The literature search generated a total of 2696 references. After removing duplicates and articles that did not meet inclusion criteria, 12 studies were included. Due to the lack of statistical analyses, pooling of data was not possible. Strong evidence indicates that increasing intervertebral disk degeneration, lateral vertebral translation C6 mm, and an intercrest line through L5 (rather than L4) are associated with DNDLS curve progression. Moderate evidence suggests that apical vertebral rotation Grade II or III is associated with curve progression. For the majority of other prognostic factors, we found limited, conflicting, or inconclusive evidence. Osteoporosis, a coronal Cobb angle \30°, lumbar lordosis, lateral osteophytes difference of C5 mm, and degenerative spondylolisthesis have not been shown to be risk factors. Clinical risk factors for progression were not identified. Conclusions This review shows strong evidence that increased intervertebral disk degeneration, an intercrest line through L5, and apical lateral vertebral translation C6 mm are associated with DNDLS curve progression. Moderate evidence was found for apical vertebral rotation (Grade II/III) as a risk factor for curve progression. These results, however, may not be directly applicable to the individual patient.

Low back pain in older adults: risk factors, management options and future directions

“…DNDLS is defined as a lumbar scoliotic curve with a Cobb angle ≥10° in the coronal plane that develops after 50 years of age in people without a history of adolescent idiopathic scoliosis. [77]. The reported prevalence of DNDLS in the adult population has ranged from 8.3 to 13.3% [78–80], while that in adults older than 60 years was as high as 68% [81].…”

“…However, no significant relation between Cobb angle and LBP symptoms in older adults has been reported [81]. Interestingly, the curve progression rate of DNDLS is higher than that of adolescent idiopathic scoliosis [77]. Three radiological variables (i.e., increased intervertebral disc degeneration, an intercrest line passing through the L5 level (not L4 or higher), and apical lateral vertebral translation for at least 6 mm)) have been identified as predictors of DNDLS curve progression [77].…”

Age-Related Progression of Degenerative Lumbar Kyphoscoliosis: A Retrospective Study

“…The progression of degenerative scoliosis causes serious disability in daily life associated with a variety of clinical symptoms, and it shortens the healthy life expectancy of elderly people. Previously reported risk factors for the progression of scoliosis include sex, the presence of vertebral lateral spondylolisthesis, and a Cobb angle > 30° 10,11) .…”

“…With the increasing numbers of patients suffering from DLKS, there have been various reports describing surgical procedures, including corrective fusion with multi-segmental posterior instrumentation, vertebral osteotomy, and lateral interbody fusion 8,9) . These reports described perioperative complications; conversely, untreated degenerative scoliosis can result in curve progression, with studies reporting various risk factors for this 10,11) . However, most of these studies analyzed cases that included both those with and without scoliosis at the time of the first measurement, and so the most important factors of curve progression may have not been fully elucidated yet.…”

Conservative Treatment of Degenerative Lumbar Scoliosis

“…DLS tends to progress irrespective of the magnitude of the curve (Figure 6) [46]. A study reported the rate of progression of scoliosis in patients with DLS to be 1.64° per year (0.77-3.82°) [7], while another study reported an increase of 3° per year in a cohort of 200 people over the age of 50 years [47]. The radiographic risk parameters are similar to that of ADIS and include apical vertebral rotation ≥ III, a Cobb angle >30°, lateral vertebral translation >6 mm., and L5 above the intercristal line, which is the line joining both iliac crests [9,47].…”