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Risk Factors and Natural Course of de Novo Degenerative Lumbar Scoliosis in a Community‐Based Cohort: The Miyama Study: PAPER #115

Tsutsui, Shunji; Watanuki, Atsunori; Yamada, Hiroshi; Nagata, Keiji; Ishimoto, Yuyu; Enyo, Yoshio; Yoshimura, Noriko; Yoshida, Munehito

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Spine Journal Meeting Abstracts: 2011 - Volume - Issue - p 115
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Summary: Degenerative lumbar scoliosis (DLS) is one of the most prevalent disorders in the aging spine. Although some authors have reported the etiology of DLS, there has been controversy regarding the prediction of the progression of de novo DLS (DNDLS). In a prospective longitudinal community‐based cohort study, the rotation of L3 in concomitant with the degenerative changes of lumbar spine might result in DNDLS. Although the incidence of DNDLS increases with the age, the magnitude of scoliosis was not progressive.

Introduction: Degenerative lumbar scoliosis (DLS) is one of the most prevalent disorders in the aging spine. Although some authors have reported the etiology of DLS, there has been controversy regarding the prediction of the progression of de novo DLS (DNDLS). The purpose of this study was to investigate risk factors and natural course of DNDLS by using a community‐based cohort.

Methods: Subjects (N=400) were selected by sex and age from a list of 1,543 district residents, born from 1910 to 1949, with 50 men and 50 women selected from each age decade. Radiographic examinations of the lumbar spine in anteroposterior and lateral views were performed in 1990 and repeated in 2005 and 2008. DNDLS was defined as newly developed scoliosis (Cobb≥10° and progression ≥5°) in 2005 or 2008.

Results: Evaluation of radiographic surveys was completed for 200 of the 400 participants in 2005 and for 154 in 2008. 12 subjects had DLS at baseline. DNDLS was found in 33 inhabitants in 2005 and 24 in 2008. None of them showed further progression of scoliosis, and their scoliotic angles were less than 30° throughout the survey. In the radiographic investigation, lateral slippage and rotation of L3 and lateral osteophyte difference at L3/4 were statistically significantly larger in the subjects with DNDLS than in those without DNDLS at baseline (p<0.01). Logistic regression analysis, which was performed with the occurrence of DNDLS as an objective factor, demonstrated that the rotation of L3 was the significant risk factor for DNDLS (odds ratio; 13.95, 95% confidence interval; 4.05‐52.34, p<0.0001).

Conclusion: In the initial stage of degenerative change of lumbar spine, asymmetric degenerative change of intervertebral discs occurs usually in the lower lumbar spine, followed by the compensation of upper lumbar levels to maintain spinal balance. Once the rotatory change of the L3 vertebra occurs, this compensation might break down, leading to scoliosis. Although the incidence of DNDLS increases with the age, the magnitude of scoliosis was not progressive.

© 2011 Lippincott Williams & Wilkins, Inc.