Spinal decompensation in degenerative lumbar scoliosis

Abstract

Due to the aging population, degenerative scoliosis is a growing clinical problem. It is associated with back pain and radicular symptoms. The pathogenesis of degenerative scoliosis lies in degenerative changes of the spinal structures, such as the intervertebral disc, the facet joints and the vertebrae itself. Possibly muscle weakness also plays a role. However, it is not clear what exactly causes the decompensation to occur and what determines the direction of the curve. It is known that in the normal spine a pre-existing rotation exists at the thoracic level, but not at the lumbar level. In this retrospective study we have investigated if a predominant curve pattern can be found in degenerative scoliosis and whether symptoms are predominantly present at one side relative to the curve direction. The lumbar curves of 88 patients with degenerative scoliosis were analyzed and symptoms were recorded. It was found that curve direction depended significantly on the apical level of the curve. The majority of curves with an apex above L2 were convex to the right, whereas curves with an apex below L2 were more frequently convex to the left. This would indicate that also in degenerative scoliosis the innate curvature and rotational pattern of the spine plays a role in the direction of the curve. Unilateral symptoms were not coupled to the curve direction. It is believed that the symptoms are related to local and more specific degenerative changes besides the scoliotic curve itself.

Orientation of the facet joints in degenerative rotatory lumbar scoliosis: an MR study on 52 patients

“…The severity of vertebral rotation was defined by an experienced radiologist according to the Nash-Moe grading system [40] in the lumbar vertebra with the most rotation [19].…”

“…Unlike congenital [3,23,27] and adolescent idiopathic scoliosis [26], degenerative scoliosis develops in a skeletally mature spine [19]. The occurrence of this type of scoliosis increases with age; so degenerative scoliosis is expected to be a growing clinical problem due to the aging population [32,49].…”

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

“…DNDLS can cause back and leg pain symptoms in patients, without a history of adolescent idiopathic scoliosis (AIS), and is radiologically characterized by a Cobb angle of 10°or more, and by asymmetrical disk and/or facet arthritis [7,[23][24][25][26][27]. In DNDLS, to date, curve progression is unpredictable.…”

Degenerative lumbar scoliosis in Chinese Han population: prevalence and relationship to age, gender, bone mineral density, and body mass index

“…Degenerative lumbar scoliosis (DLS) is defined as a lumbar scoliosis developing during adulthood without previous history of scoliosis [1][2][3][4][5]. In recent years, increasing attention has been paid to the diagnoses and management of DLS with the population aging worldwide.…”