Abstract
Adult lumbar scoliosis is an increasingly recognized entity that may contribute to back pain. We investigated the epidemiology of lumbar scoliosis and the rate at which it is unreported on lumbar MR images. The coronal and sagittal sequences of lumbar spine MR imaging scans of 1299 adult patients, seeking care for low back pain, were reviewed to assess for and measure the degree of scoliosis and spondylolisthesis. Findings were compared with previously transcribed reports by subspecialty trained neuroradiologists. Inter- and intraobserver reliability was calculated. The prevalence of adult lumbar scoliosis on MR imaging was 19.9%, with higher rates in ages >60 years (38.9%, P < .001) and in females (22.6%, P = .002). Of scoliotic cases, 66.9% went unreported, particularly when the scoliotic angle was <20 degrees (73.9%, P < .001); 10.5% of moderate to severe cases were not reported. Spondylolisthesis was present in 15.3% (199/1299) of cases, demonstrating increased rates in scoliotic patients (32.4%, P < .001), and it was reported in 99.5% of cases. Adult lumbar scoliosis is a prevalent condition with particularly higher rates among older individuals and females but is underreported on spine MR images. This can possibly result in delayed 1) identification of a potential cause of low back pain, 2) referral to specialized professionals for targeted evaluation and management, and 3) provision of health care. The coronal "scout images" should be reviewed as part of the complete lumbar spine evaluation if dedicated coronal sequences are not already part of the spine protocol.
Highlights
AND PURPOSE: Adult lumbar scoliosis is an increasingly recognized entity that may contribute to back pain
Adult lumbar scoliosis is a prevalent condition with higher rates among older individuals and females but is underreported on spine MR images
We evaluated the rate at which adult lumbar scoliosis and spondylolisthesis are reported in lumbar spine MR imaging reports and addressed its implications vis-a-vis health care provision
Summary
The coronal and sagittal sequences of lumbar spine MR imaging scans of 1299 adult patients, seeking care for low back pain, were reviewed to assess for and measure the degree of scoliosis and spondylolisthesis. Coronal scout images were reviewed to evaluate lumbar scoliosis in accordance with the Scoliosis Research Society criterion (ie, single scoliosis with the apical vertebra between L1 and L2 disk to L4 vertebral body).[27] Curve angulations were measured digitally with reference to the summit vertebrae (Fig 1). Those measuring Ͼ10° were termed scoliotic and the rest were labeled nonscoliotic. The differences based on sex and age groups were documented for prevalence, scoliotic degrees, and direction of the curve
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