Epidemiological, Clinical, and Radiological Profile of Patients with Degenerative Scoliosis: Experience of 20 Years at the National Institute of Rehabilitation

Abstract

Introduction Adult scoliosis is a complex three-dimensional rotational deformity of the spine result in a progressive degeneration, with a Cobb angle greater than 10 degrees in the coronal plane, which alters the sagittal and axial planes, it occurs in a previously straight spine; most often in elderly. The adult degenerative or de novo scoliosis is believed to develop as the result of asymmetric degeneration of the discs, osteoporosis, and vertebral body compression fractures; this causes increased asymmetric loading and therefore a progression of degeneration and deformity. The main symptom is pain; and the surgical treatment is preferred for patients with neurological deficit, severe pain, or radiculopathy. Risk factors are female gender, age over 50 years, osteoporosis; and for curve progression may be a curve size over 30 degrees, an asymmetric disc above and below the apical vertebra, lateral subluxation of the apical vertebra over 6 mm, and L5 vertebra being located above rather than below the intercrestal line. The degenerative scoliosis prevalence varies from 2.5 to 15% in controlled populations. The increase in life expectancy in our population and the pursuit of improving the quality of life has turned degenerative scoliosis in a common problem of medical care. The main objective of this study is to examine the epidemiological, clinical, and radiographical features of patients with this disease who have been diagnosed and treated in an institution of concentration in the past 20 years. Patients and Methods We retrospectively analyzed electronic and radiographic records of patients between 40 to 80 years, diagnosed with adult degenerative scoliosis who have undergone surgery in our institute, during the period from January 1995 to December 2013. Results The prevalence was 0.087%, with a total of 61 individuals. We observed increased frequency of degenerative lumbar scoliosis in women (72.1%), at a rate of 2.6:1 and also an increase in the frequency in older adults (70.5%) (43/61). The prevalence of degenerative spondylolisthesis associated with lumbar scoliosis was 21%. In a gender analysis in women, increased prevalence was 3.52%; women have an increased frequency of spondylolisthesis compared with men. Women had 2.4 times the risk of degenerative lumbar scoliosis. Men had 1.9 times the risk of degenerative spondylolisthesis associated with lumbar scoliosis. The most affected level was L4–L5. Conclusion Although degenerative scoliosis is a common disease that affects the adult population, the prevalence in our institute is low compared with international literature and the age of our sample was higher than that the of the series presented, this is because patients come late to the care for not having medical service. The distribution of gender, the severity of the curvature, and the presence of spondylolisthesis and olisthesis was similar to the literature review.