Factors predicting progression in early degenerative lumbar scoliosis.

PURPOSE

To review early radiographs of patients with de novo degenerative lumbar scoliosis to determine factors predicting early scoliosis progression.

METHODS

Standing anteroposterior and lateral radiographs of 7 men and 20 women aged 48 to 83 (mean, 63) years with Cobb angles between >5º and <20º were reviewed. They were followed up for a mean of 12 (range, 10-18) years. Radiographic variables measured included (1) the Cobb angle, (2) the grade of rotation of the apical lumbar vertebra, (3) the presence of a lateral vertebral translation of ≥3 mm, (4) the degree of osteoporosis, and (5) the Harrington factor (the degree of scoliosis divided by the number of vertebrae involved).

RESULTS

During the follow-up period, the mean Cobb angle increased 5.3º from 10.1º to 15.4º, representing an increase of 0.4º per year. In initial radiographs, the apical vertebral rotation was rated as grade 0 in 3 patients, grade 1 in 19, grade 2 in 4, and grade 3 in one. A lateral vertebral translation of ≥3 mm was noted in 9 patients. The degree of osteoporosis was rated as grade 0 in 9 patients, grade 1 in 11, grade 2 in 5, and grade 3 in 2. The mean Harrington factor was 2.4. In the multiple regression analysis, only the grade of apical vertebral rotation was significantly correlated with scoliosis progression (regression coefficient=0.502, p=0.009).

CONCLUSION

Apical vertebral rotation may help predict the scoliosis progression and determine the timing of surgical intervention in patients with early degenerative lumbar scoliosis.