The clinical features and surgical treatment of degenerative lumbar scoliosis: a review of 112 patients

Abstract

Objective: To investigate the clinical features, radiological characteristics and surgical results of degenerative lumbar scoliosis (DLS).

Methods: One hundred and twelve cases of DLS treated surgically from June 2001 to February 2006 were retrospectively reviewed for clinical features, characteristics of nerve root compression and imaging presentations. According to the preoperative clinical manifestations and imaging findings, different surgical modalities were performed, including simple nerve decompression and decompression with short or long posterior fusion (less or more than three segments, respectively).

Results: The mean age of 47 male and 65 female patients was 54.7 years. Clinical manifestations included lower back pain (76.8%), radiculopathy (79.5%) and claudication (48.2%). Plain lumbar radiograph showed right scoliosis in 87 and left scoliosis in the other 25 cases; the Cobb angle was 10°-46°; the apex of scoliosis mostly located at L3 (48.2%); L3 and L4 nerve roots were usually compressed on the concave side and L5 and S1 nerve roots on the convex side. The Cobb angle and physiologic lordosis angle of patients who underwent multi-segment (>3 segments) fusion improved to a greater extent than did that of patients who had simple decompression without fusion. A mean 5.7-year follow-up showed that the average improvement in Oswestry disability index (ODI) scores was 32.6, 26.3 and 13.5 for long segment fusion, short segment fusion and simple decompression without fusion, respectively.

Conclusion: Decompression surgery with or without fusion, the main purpose of which is to relieve nerve root compression and stabilize the spinal column, is an effective treatment for chronic DLS. The treatment should be individualized according to the patient's age, general and economic factors, severity of deformity and other coexisting lumbar degenerative disorders.

Figure 1

Imaging findings in a 70‐year‐old man with DLS. This patient, who was in very poor general condition, complained of low back pain, severe claudication and radiculopathy. (a) Anteroposterior and (b) lateral radiographs show degenerative lumbar scoliosis (DLS) with segmental instability and (c) CT scan shows spinal stenosis in the L3–L4 and L4–L5 segments. A nerve decompression with short fusion was performed and produced a good result after 3.5 years follow‐up (d) anteroposterior radiograph, (e) lateral radiograph.

Figure 2

Imaging findings in a 59‐year‐old man with DLS. This patient complained of low back pain and claudication. Standing lumbar radiographs show (a) a lordosis angle of 22° and (b) a Cobb angle of 24°. (c) With myelography severe central canal stenosis was observed below the L2 vertebra. (d) The lordosis angle was significantly improved after broad decompression and long fusion surgery to 40° and (e) the Cobb angle to 3°.