Article
Degenerative lumbar scoliosis – anamnestic, clinical and radiological evaluation of patients needing fusion surgery. A retrospective descriptive trial
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Authors
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David Grabler
- Medizinische Universität Wien, Wien, Österreich
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Werner Lack
- Orthopädische Ordination Univ. Doz. Dr. Werner Lack, Wien, Österreich
| Published: | June 18, 2018 |
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Outline
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Objective: To analyze anamnestic, radiological and clinical findings of patients with degenerative lumbar scoliosis (DLS) requiring fusion surgery.
Methods: Investigation of 92 patients with DLS which were treated by fusion of the scoliotic curve in the space of time from January 2006 to October 2016. Preoperative anamnestic, radiological and clinical findings were documented and analyzed in a retrospective descriptive manner. Patients with progressive idiopathic scoliosis as well as secondary degenerative scoliosis were excluded.
Results: In this collective there was a female predominance of 85% with an age of about 69 years at time of surgery. Sex has not shown any significant statistical differences. DLS includes approximately four segments on average and runs mostly from D12 to L4. The relation between right and left convex scoliosis was absolutely balanced with 50 % on each side. Cobb angle averaged approximately 23°. Almost 90% complained of low back pain with a VAS > 5. Two-thirds of the patients presented with sciatic pain. About 15 % had symptoms in terms of spinal claudication. Flatback-syndrome was found in one third of the patients. Decreased bone density did not reveal any influences on the deformity. Most frequent degenerative changes were degenerative disc disease (ca. 80 %, most commonly L2/3 and L3/4), followed by foraminal stenosis (63 %, most commonly located at L4 respectively at the concavity of the major curve and lumbosacral hemicurve), spinal canal stenosis (ca. 58 %, with a maximum at L3/4 and L4/5), rotational/lateral spondylolisthesis (ca. 53 %, most commonly L3/4) and degenerative spondylolisthesis (ca. 48 %, mostly L4). Elderly patients showed lower Cobb angles (p<0,05).
Conclusion: De novo degenerative lumbar scoliosis is caused by asymmetric disc disease at L2/3 and L3/4. It is accompanied by a reduced lumbar lordosis leading to flatback syndrome in one third of patients. Foraminal stenosis is mostly located at the apex at the concavity of the major curve and lumbosacral hemicurve. Degenerative spondylolisthesis of L3 and L4 leads to spinal canal stenosis in the segments L3/4 and L4/5. Patients require fusion surgery due to severe low back pain, sciatica, symptoms of spinal claudication and degenerative changes of the spine.
