RADIOGRAPHIC ANALYSIS OF DE NOVO SCOLIOSIS

Objectives. To analyze the degenerative process in the lumbar spine in patients with and without scoliosis, in order to determine potential risk factors, which may be related to the development of de novo scoliosis.

Material and Methods. In 121 adults (≥50 years), analyzed radiological parameters included: listhesis, wedging, and height of each lumbar vertebra, wedging and height of each disc, length of vertebral spurs, lumbar lordosis, lumbosacral, lumbo (L5) horizontal and sacro-horizontal angles, pelvic tilt on A-P X-ray, depth of L5 from the intercrest line, also – if present – pattern of curve, and level prsenting with the most obvious degenerative changes (MODC). Uni- and multi-variate statistical tests were used for analysis.

Results. Degenerative changes were most obvious in the middle lumbar region. MODC at the L2 vertebra/L2–L3 disc and L4 vertebra/L4–L5 disc levels were more frequent in cases with scoliosis (p = 0.013; p = 0.022, respectively). Upon multivariate analysis the presence of scoliosis was closely related to the presence of lateral listhesis of L3, wedging of L3–L4disc, or pelvic tilt (p = 0.000; p = 0.000; p = 0.001, respectively). Cases with MODC at the L3–L4 disc level, or a more cranial apex of curve had a higher degree of scoliosis (p = 0.009; p = 0.017, respectively). Whereas, MODC at the L5–S1 level coexist with a low degree or no scoliosis (p = 0.009). Degenerative changes in the middle lumbar region, and pathologic conditions in the hip or lower extremities resulting in pelvic tilt, are frequent findings in cases with de novo scoliosis. Likewise, asymmetric degenerative changes at the L3–L4 disc level, and a more cranial apex of curve, were associated with an increased scoliotic curve. However, degenerative changes at the L5 vertebra/L5–S1 disc level carries lower risk in producing scoliosis.

Conclusion. Degenerative changes in the lumbar spine are more intensive in its upper and middle parts, particularly at the level of L3 vertebral body and L3–L4 disc.

1. Grubb S.A., Lipscomb H.J., Coonrad R.W. Degenerative adult onset scoliosis // Spine. 1988; 13 (3): 241–245.

2. Isaza J.E., Londono F., Myers L.A., Holt R.T., Whitecloud T.S. De Novo scoliosis: definition and clinical classification. Scoliosis Research Society 32nd Annual Meeting Final Program, exhibit #24, page 141, St. Louis, Missouri, September 25–27, 1997.

3. Grubb S.A., Lipscomb H.J. Diagnostic findings in painful adult scoliosis // Spine. 1992; 17 (5): 518–527.

4. Robin G.C., Span Y., Steinberg R., Makin M., Menczel J. Scoliosis in the elderly. A follow-up study // Spine. 1982; 7 (4): 355–359.

5. Schwab F.J., Smith V.A., Biserni M., Gamez L., Farcy J.P.C., Pagala M. Adult Scoliosis. A quantitative radiographic and clinical analysis // Spine. 2002; 27 (4): 387–392.

6. Esses S.I., Doherty B. Biomechanics of the spine. In: Esses SI (ed) Textbook of Spinal Disorders. J.B. Lippincott, Philadelphia, 1995: 109-134.

7. Pritchett J.W., Bortel D.T. Degenerative symptomatic lumbar scoliosis // Spine. 1993; 18 (6): 700–703.

8. Sapkas G., Efstathiou P., Badekas A.T., Antoniadis A., Kyratzoulis J., Meleteas E. Radiological parameters associated with the evolution of degenerative scoliosis. Bull Hosp Joint Dis 1996; 55 (1): 40–45.

9. White A.A., Panjabi M.M. Clinical Biomechanics of the Spine. 2nd ed. J.B. Lippincott, Philadelphia, 1990: 109–121.

10. Gillespy T III, Gillespy T.Jr., Revak C.S. Progressive senile scoliosis: Seven cases of increasing spinal curves in elderly patients. Skeletal Radiology 1985; 13: 280–286.