Ishihara Yohei, Morishita Masutaro, Kanzaki Koji, Toyone Tomoaki
Asao General Hospital Spine Center, Kawasaki, Japan.
Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Spine Surg Relat Res. 2020 Mar 19;4(3):229-236. doi: 10.22603/ssrr.2019-0113. eCollection 2020.
Degenerative lumbar kyphoscoliosis is a serious clinical condition that affects activities of daily living. This study aimed to investigate the age-related progression of nonoperative degenerative lumbar kyphoscoliosis, to clarify its final state in elderly people, and to identify factors associated with its progression.
This retrospective longitudinal study included 115 nonoperative cases (mean age at first consultation, 70.9 years; range, 50-89 years). All were followed up for >6 years. The analysis included changes between initial and latest measurements in the coronal parameters (Cobb angle, L4 tilt angle, intervertebral angle, lateral spondylolisthesis, and C7-central sacral vertical line) and sagittal parameters (thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis, and vertebral wedging rate). Factors in scoliosis progression were investigated by analyzing the correlations between the initial parameter values and the increase in Cobb angle.
Changes in the coronal parameters increased with age from 50s to 70s but decreased significantly in those aged 80s. Sagittal parameters increased by the age group, accelerating in those aged 80s, with the progression of vertebral wedging. In patients aged 50s-70s, the increase in Cobb angle correlated significantly with the initial Cobb angle, L4 tilt angle, and L4/L5 intervertebral angle. However, in the cases without initial scoliosis, the increase in Cobb angle correlated significantly only with the L4 tilt angle. There were no significant differences in any parameter according to the use of a trunk brace or medication for osteoporosis.
L4 tilt angle is an important factor in the progression of degenerative scoliosis. The progression of scoliosis gradually ends after the age of 80 years with the decreasing variation of L4 tilt angle, whereas kyphosis accelerates with aging, especially in those aged >80 years, with the progression of vertebral wedging.
退行性腰椎后凸侧弯是一种影响日常生活活动的严重临床病症。本研究旨在调查非手术性退行性腰椎后凸侧弯与年龄相关的进展情况，阐明其在老年人中的最终状态，并确定与其进展相关的因素。
这项回顾性纵向研究纳入了115例非手术病例（首次就诊时的平均年龄为70.9岁；范围为50 - 89岁）。所有患者均接受了超过6年的随访。分析内容包括冠状面参数（Cobb角、L4倾斜角、椎间角、侧方椎体滑脱以及C7 - 骶骨中心垂直线）和矢状面参数（胸椎后凸、腰椎前凸、骨盆入射角、骨盆倾斜度、骶骨斜率、矢状垂直轴以及椎体楔变率）在初始测量和最新测量之间的变化。通过分析初始参数值与Cobb角增加之间的相关性来研究脊柱侧弯进展的因素。
冠状面参数的变化在50多岁至70多岁时随年龄增加，但在80多岁时显著下降。矢状面参数随年龄组增加，在80多岁时加速增加，同时椎体楔变也在进展。在50多岁至70多岁的患者中，Cobb角的增加与初始Cobb角、L4倾斜角以及L4/L5椎间角显著相关。然而，在初始无脊柱侧弯的病例中，Cobb角的增加仅与L4倾斜角显著相关。根据是否使用躯干支具或骨质疏松药物治疗，任何参数均无显著差异。
L4倾斜角是退行性脊柱侧弯进展的一个重要因素。脊柱侧弯的进展在80岁以后随着L4倾斜角变化的减少而逐渐停止，而后凸随着年龄增长加速，尤其是在80岁以上的人群中，同时椎体楔变也在进展。
