European Spine Journal

, Volume 23, Supplement 6, pp 597–603 | Cite as

Adult scoliosis: age-related deformity and surgery

  • Silvana De Giorgi
  • Giuseppe De Giorgi
  • Carmela Borracci
  • Silvio Tafuri
  • Andrea Piazzolla
  • Biagio Moretti
Original Article



We retrospectively analyzed our results in thoracolumbar and lumbar adolescent idiopathic scoliosis treated during adulthood.


Fifty-two thoracolumbar and 30 lumbar idiopathic scoliosis surgically treated were reviewed. Mean follow-up was 9.5 ± 6.6 years. All the subjects were analyzed by visual analog scale, Oswestry Disability Index (ODI), and SF-36 scores before and after surgery and at follow-up. The scoliotic curve, thoracic kyphosis, lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT), sacral slope, and C7 plumb line were measured. For the statistical analysis, multivariate multiple regression models were formulated, considering as significative a P < 0.05.


A statistically significant clinical and radiological amelioration was noted after surgery and at final follow-up. According to the logistic regression model, ODI was related to lumbar lordosis and spino-pelvic parameters at follow-up. The only determinant of failure was age.


Spino-pelvic recovery is easier in patients aged less than 60 years with PI < 55° and PT < 25°.


Adult scoliosis Sagittal balance Spino-pelvic parameters Spine 


Conflict of interest



  1. 1.
    Le Huec JC, Charosky S, Barrey C, Rigal J, Aunoble S (2011) Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J 20(S5):S699–S703CrossRefGoogle Scholar
  2. 2.
    Aebi M (2005) The adult scoliosis. Eur Spine J 14(10):925–948PubMedCrossRefGoogle Scholar
  3. 3.
    Guillaumat M (1999) Natural history of scoliosis from childhood to old age. Bull Acad. Nati Med 183(4):705–718Google Scholar
  4. 4.
    Cotrel Y, Dubousset J, Guillaumat M (1988) New universal instrumentation in spinal surgery. Clin Orthop Relat Res 227:10–23PubMedGoogle Scholar
  5. 5.
    Stagnara P, De Mauroy JC, Dran G, Gonon G, Costanzo G, Dimnet J, Pasquet A (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7(4):335–342PubMedCrossRefGoogle Scholar
  6. 6.
    Stagnara P (1982) Scoliosis in adults. Consequences of idiopathic scoliosis in adulthood. Chirurgie 108(4):356–363PubMedGoogle Scholar
  7. 7.
    Dubousset J (1994) Three dimensional analysis of the scoliotic deformity. In: Weinstein SL (ed) Pediatric spine: principles and practice. Raven, New YorkGoogle Scholar
  8. 8.
    Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7(2):99–103PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Roussouly P, Labelle H, Rouissi J, Bodin A (2012) Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J 22:S203–S215. doi: 10.1007/s00586-012-2571-x PubMedCrossRefGoogle Scholar
  10. 10.
    Roussouly P, Berthonnaud E, Dimnet J (2003) Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: proposed classification. Rev Chir Reparatr App Mot 89(7):632–639Google Scholar
  11. 11.
    Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumbline: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31(11):E320–E325PubMedCrossRefGoogle Scholar
  12. 12.
    Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353PubMedCrossRefGoogle Scholar
  13. 13.
    Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Farcy JP, Schwab FJ (1997) Management of flatback and related kyphotic decompensation syndromes. Spine 22:2452–2457PubMedCrossRefGoogle Scholar
  15. 15.
    Le Huec JC, Aunoble S, Leijssen P, Pellet N (2011) Pelvic parameters: origin and significance. Eur Spine J 20(S5):S564–S571CrossRefGoogle Scholar
  16. 16.
    Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine 35(22):E1193–E1198PubMedCrossRefGoogle Scholar
  17. 17.
    De Wald CJ, Stanley T (2006) Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65. Spine 31:S144–S151CrossRefGoogle Scholar
  18. 18.
    Berjano P, Lamartina C (2013) Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J 22:S242–S253PubMedCrossRefGoogle Scholar
  19. 19.
    Lafage V, Schwab F, Vira S, Patel A, Ungar B, Frcy JP (2011) Spino-pelvic parameters after surgery can be predicted: a preliminary formula and validation of standing alignment. Spine 36(13):1037–1045PubMedCrossRefGoogle Scholar
  20. 20.
    Murata Y, Takahashi K, Yamagata M, Hanaoka E, Moriya H (2003) The knee-spine syndrome. Association between lumbar lordosis and extension of the knee. J Bone Joint Surg Br 85:95–99PubMedCrossRefGoogle Scholar
  21. 21.
    Mangione P, Senegas J (1997) L’équilibre rachidien dans le plan sagittal. Rev Chir Orthop 83:22–32PubMedGoogle Scholar
  22. 22.
    Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM, Kim YJ (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine 34(8):785–791PubMedCrossRefGoogle Scholar
  23. 23.
    Van Royen BJ, De Gast A, Smit TH (2000) Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J 9(6):492–498PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Berthonnaud E, Dimner J, Roussouly P, Labelle H (2004) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spine Disord 18(1):40–47CrossRefGoogle Scholar
  25. 25.
    Danisa OA, Turner D, Richardson WJ (2000) Surgical correction of lumbar kyphotic deformity: posterior reduction “eggshell” osteotomy. J Neurosurg 92(S1):50–56PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Silvana De Giorgi
    • 1
    • 3
  • Giuseppe De Giorgi
    • 1
  • Carmela Borracci
    • 1
  • Silvio Tafuri
    • 2
  • Andrea Piazzolla
    • 3
  • Biagio Moretti
    • 1
    • 3
  1. 1.Department of Basic Medical Sciences, Neurosciences and Sensory OrgansUniversity of BariBariItaly
  2. 2.Department of Biomedical Science and Human OncologyUniversity of BariBariItaly
  3. 3.Az. Ospedaliero-Universitaria Policlinico di BariBariItaly

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