Abstract
Degenerative lumbar scoliosis (DLS) or “de novo scoliosis” represents a pathological condition associated with rotational subluxation and anteroposterior or lateral olisthesis leading to coronal deformity. DLS is defined as a coronal Cobb angle of more than 10° but rarely exceeding 50°. The etiological progress is multifactorial and still unclear but starting with intervertebral disc degeneration, facet joint degeneration and changes in canal as well as pedicle morphology. The scoliotic curve typically develops in the fifth decade of life and is not based on idiopathic adolescent scoliosis (AIS). Life time prevalence is between 8–13% increasing with age, so that the prevalence in the sixth decade of life rises up to 60% with women being more frequently affected than men. In contrast to patients with AIS, the clinical symptomatology in DLS patients is usually characterized by low back pain, neurogenic claudication associated with neurological deficits in the lower extremities and rarely cauda equina syndrome. The spinal deformity shows a mean annual curvature progression in the coronal plain of 3–4°, although the progression does not translate linearly, so that the prognosis which curve is progressing cannot be reliably predicted. Nevertheless, the literature provides evidence, that increased intervertebral disc degeneration, lateral translation >6 mm and an intercrest line through the L5 vertebra may be considered as progression factors of these coronal deformities. The majority of DLS show an accompanied segmental kyphosis resulting in moderate or severe sagittal imbalance. As a result, a classification system of degenerative disc disease based on the distribution of the diseased segments and the balance status of the spine has been generated to guide the treatment of DLS. Therefore, the treatment of DLS patients is characterized by a wide variability of surgical options ranging from simple lumbar nerve root decompression to complex thoracolumbar fusions with sagittal deformity corrections. The surgical treatment is even more complex due to the accompanied comorbidities associated with the increased age in DLS patients.
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References
Aebi M. The adult scoliosis. Eur Spine J. 2005;14(10):925–48. https://doi.org/10.1007/s00586-005-1053-9.
Berjano P, Lamartina C. Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine. Eur Spine J. 2014;23(9):1815–24. https://doi.org/10.1007/s00586-014-3219-9.
Carter OD, Haynes SG. Prevalence rates for scoliosis in US adults: results from the first national health and nutrition examination survey. Int J Epidemiol. 1987;16(4):537–44.
Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D. Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine (Phila Pa 1976). 2012;37(8):693–700. https://doi.org/10.1097/BRS.0b013e31822ff5c1.
Chin KR, Furey C, Bohlman HH. Risk of progression in de novo low-magnitude degenerative lumbar curves: natural history and literature review. Am J Orthop (Belle Mead NJ). 2009;38(8):404–9.
Faraj SS, Holewijn RM, van Hooff ML, de Kleuver M, Pellisé F, Haanstra TM. De novo degenerative lumbar scoliosis: a systematic review of prognostic factors for curve progression. Eur Spine J. 2016;25(8):2347–58. https://doi.org/10.1007/s00586-016-4619-9.
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky RL. Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender. Spine (Phila Pa 1976). 2011;36(9):731–6. https://doi.org/10.1097/BRS.0b013e3181e9f120.
Kobayashi T, Atsuta Y, Takemitsu M, Matsuno T, Takeda N. A prospective study of de novo scoliosis in a community based cohort. Spine (Phila Pa 1976). 2006;31(2):178–82.
Lee C-H, Chung CK, Sohn MJ, Kim CH. Short limited fusion versus long fusion with deformity correction for spinal stenosis with balanced de novo degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2017;42(19):E1126–32. https://doi.org/10.1097/BRS.0000000000002306.
Le Huec JC, Leijssen P, Duarte M, Aunoble S. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J. 2011;20(Suppl 5):669–80. https://doi.org/10.1007/s00586-011-1935-y.
Liu H, Ishihara H, Kanamori M, Kawaguchi Y, Ohmori K, Kimura T. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine J. 2003;3(6):524–9.
Liu W, Chen XS, Jia LS, Song DW. The clinical features and surgical treatment of degenerative lumbar scoliosis: a review of 112 patients. Orthop Surg. 2009;1(3):176–83. https://doi.org/10.1111/j.1757-7861.2009.00030.x.
Lowe T, Berven SH, Schwab FJ, Bridwell KH. The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems. Spine (Phila Pa 1976). 2006;31(19 Suppl):S119–25. https://doi.org/10.1097/01.brs.0000232709.48446.be.
Phan K, Xu J, Maharaj MM, Li J, Kim JS, Di Capua J, et al. Outcomes of short fusion versus long fusion for adult degenerative scoliosis: a systematic review and meta-analysis. Orthop Surg. 2017;9(4):342–9. https://doi.org/10.1111/os.12357.
Pritchett JW, Bortel DT. Degenerative symptomatic lumbar scoliosis. Spine (Phila Pa 1976). 1993;18(6):700–3.
Robin GC, Span Y, Steinberg R, Makin M, Menczel J. Scoliosis in the elderly: a follow-up study. Spine (Phila Pa 1976). 1982;7(4):355–9.
Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 2005;30(3):346–53.
Schwab F, el-Fegoun AB, Gamez L, Goodman H, Farcy JP. A lumbar classification of scoliosis in the adult patient: preliminary approach. Spine (Phila Pa 1976). 2005;30(14):1670–3.
Schwab F, Lafage V, Farcy JP, Bridwell K, Glassman S, Ondra S, et al. Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis: application of the new adult deformity classification. Spine (Phila Pa 1976). 2007;32(24):2723–30. https://doi.org/10.1097/BRS.0b013e31815a58f2.
Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976). 2010;35(25):2224–31. https://doi.org/10.1097/BRS.0b013e3181ee6bd4.
Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, et al. Scoliosis research society-schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976). 2012;37(12):1077–82. https://doi.org/10.1097/BRS.0b013e31823e15e2.
Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M. Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976). 2002;27(4):387–92.
Smith JS, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, et al. Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up. Neurosurgery. 2016;78(6):851–61. https://doi.org/10.1227/NEU.0000000000001116.
Transfeldt EE, Topp R, Mehbod AA, Winter RB. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine (Phila Pa 1976). 2010;35(20):1872–5. https://doi.org/10.1097/BRS.0b013e3181ce63a2.
Tribus CB. Degenerative lumbar scoliosis: evaluation and management. J Am Acad Orthop Surg. 2003;11(3):174–83.
Watanuki A, Yamada H, Tsutsui S, En-yo Y, Yoshida M, Yoshimura N. Radiographic features and risk of curve progression of de-novo degenerative lumbar scoliosis in the elderly: a 15-year follow-up study in a community-based cohort. J Orthop Sci. 2012;17(5):526–31. https://doi.org/10.1007/s00776-012-0253-5.
Xu L, Sun X, Huang S, Zhu Z, Qiao J, Zhu F, et al. Degenerative lumbar scoliosis in chinese han population: prevalence and relationship to age, gender, bone mineral density, and body mass index. Eur Spine J. 2013;22(6):1326–31. https://doi.org/10.1007/s00586-013-2678-8.
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Hartmann, S., Tschugg, A., Thomé, C. (2019). Basic Degenerative Lumbar Scoliosis. In: Meyer, B., Rauschmann, M. (eds) Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-98875-7_13
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