Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan.
Spine (Phila Pa 1976). 2012 Sep 15;37(20):1763-70. doi: 10.1097/BRS.0b013e3182575eaa.
A 12-year prospective study of pre-existing and de novo degenerative lumbar scoliosis (DLS) among community-based female volunteers.
To investigate serial entire spine radiographs of healthy female volunteers and to clarify radiographical characteristics and predictors of pre-existing and de novo DLS.
DLS is among the most frequent spinal defomities in the aging spine; however, the onset or the natural course of this condition has not been elucidated.
A total of 144 female volunteers were recruited from population register. Radiographical measurements using entire spine radiographs included thoracic kyphosis (T4-12), lumbar lordosis (LL) (L1-5), sacral inclination angle, pelvic incidence, sagittal balance (C7 plumb), coronal L4 endplate angle (L4 tilt), and scoliotic angle by Cobb method. More than 10° of scoliosis was diagnosed as DLS. L4 vertebral size was measured (divided by body height) as well as lateral osteophyte formation and lateral disc wedge angle.
Mean baseline age and follow-up period were 54.4 years and 12.1 years, respectively. Pre-existing DLS (pre-DLS) was found in 42 subjects (29.2%) at baseline. Among pre-DLS, 11 subjects (26%) showed more than 5° progression in scoliosis. De novo DLS has developed in 30 subjects (29.4%) among those without baseline scoliosis.Cox proportional hazards models revealed younger age, smaller L4 size, lower LL, greater DLS angle, and L4 tilt at baseline to be the risk factors of progression of pre-DLS and smaller L4 size, unilateral osteophyte formation, and lateral disc wedging to the risk of development of de novo DLS.
This study indicated that younger age, smaller L4 size, lower LL, greater DLS angle, and L4 tilt at baseline should be evaluated as predictors of progression of pre-DLS. Early signs of asymmetric disc degeneration and smaller L4 size should also be evaluated as predictors of development of de novo DLS.
一项针对社区女性志愿者中既有和新发退行性腰椎侧凸（DLS）的 12 年前瞻性研究。
研究健康女性志愿者的连续全脊柱 X 线片，阐明既有和新发 DLS 的影像学特征和预测因素。
DLS 是老年人脊柱最常见的脊柱畸形之一；然而，这种情况的发病或自然病程尚未阐明。
从人口登记册中招募了 144 名女性志愿者。使用全脊柱 X 线片进行的影像学测量包括胸椎后凸角（T4-12）、腰椎前凸角（LL）（L1-5）、骶骨倾斜角、骨盆入射角、矢状面平衡（C7 铅垂线）、冠状位 L4 终板角（L4 倾斜角）和 Cobb 法测量的脊柱侧凸角度。超过 10°的脊柱侧凸被诊断为 DLS。还测量了 L4 椎体大小（除以身高）以及侧向骨赘形成和侧向椎间盘楔形角。
平均基线年龄和随访时间分别为 54.4 岁和 12.1 年。基线时有 42 名受试者（29.2%）存在既有 DLS（pre-DLS）。在 pre-DLS 中，有 11 名受试者（26%）的脊柱侧凸进展超过 5°。在基线无脊柱侧凸的受试者中，新发 DLS 发展 30 例（29.4%）。Cox 比例风险模型显示，基线时年龄较小、L4 较小、LL 较小、DLS 角较大和 L4 倾斜角较大是 pre-DLS 进展的危险因素，而 L4 较小、单侧骨赘形成和外侧椎间盘楔形是新发 DLS 发展的危险因素。
本研究表明，基线时年龄较小、L4 较小、LL 较小、DLS 角较大和 L4 倾斜角较大应作为 pre-DLS 进展的预测因素。不对称性椎间盘退变的早期征象和 L4 较小也应作为新发 DLS 发展的预测因素。
