Abstract
ABSTRACT Objective: To evaluate the impact of the severity of degenerative lumbar disease (DLD) on the occurrence of spinal deformity, as well as on the choice of treatment, whether conservative or surgical. Methods: This is a retrospective analysis of a prospective database. One hundred and thirty patients with low back pain and/or pain radiating to the lower limbs were included in the study and were graded on a DLD scale that considers total spine (panoramic) X-ray findings. The rates of adult spinal deformity (ASD) for the different degrees of the DLD scale were compared using the Chi-square test. The choice of treatment type, conservative or surgical, was also compared among the degrees of the DLD scale using Fisher's exact test. Results: The ASD rate was zero in grade 0 patients, 24% in grade I, 35% in grade II and 44% in grade III (P = 0.02). Grade III patients were more likely to be diagnosed with ASD (OR = 2.22; P <0.05; 95% CI = 0.90-5.45) compared to the other DLD grades. Only 7.7% of the patients were chosen for surgical treatment and there was no difference by the DLD scale grade. Conclusion: There was correlation between the DLD grading scale and the occurrence of ASD, with at least twice the chance of this diagnosis in DLD scale grade III as compared to the other grades. The treatment of choice was conservative in a very small number of patients analyzed, with no difference between the different grades of the DLD grading scale. Level of Evidence III; Retrospective analysis of prospective database (cohort).
Highlights
The use of total spine radiography in the evaluation of patients with chronic low back pain has become increasingly popular because this modality allows the observation of both radiographic changes in the lumbar segment of the spine and spinal alignment in the coronal and sagittal planes, as well as the measurement of spinopelvic parameters.[1]The association between changes in spinopelvic parameters and symptomology, including pain and functional disability, is well established as demonstrated in several studies.[2,3,4] This correlation was the basis for the development of the SRS-Schwab classification system for adult spinal deformity (ASD).[5]
No grade 0 patients were diagnosed with ASD, while the diagnosis occurred in 24% of grade I patients, 35% of grade II patients, and 44% of grade III patients (Figure 2, Table 1), with a statistically significant difference (P = 0.02)
Patients classified as grade III on the degenerative lumbar disease (DLD) grading scale had higher odds of having an ASD diagnosis (OR = 2.22, P < 0.05, 95% CI = 0.90-5.45) than the other DLD grades
Summary
The use of total spine radiography in the evaluation of patients with chronic low back pain has become increasingly popular because this modality allows the observation of both radiographic changes in the lumbar segment of the spine and spinal alignment in the coronal and sagittal planes, as well as the measurement of spinopelvic parameters.[1]The association between changes in spinopelvic parameters and symptomology, including pain and functional disability, is well established as demonstrated in several studies.[2,3,4] This correlation was the basis for the development of the SRS-Schwab classification system for adult spinal deformity (ASD).[5]. Magnetic resonance continues to be considered the gold standard imaging examination for the evaluation of degenerative changes in the spine,[7] the radiographic examination allows the identification of findings associated with spondylosis, including osteophytosis, loss of disc height, sclerosis, and subchondral cysts in the vertebral plateaus.[8] Recently, a severity scale for degenerative lumbar disease (DLD) that considers a total spine radiographic examination and assesses the presence of radiographic signs of spondylosis, its extension throughout the lumbar segments, and the presence of signs of instability, such as spondylolisthesis or laterolisthesis, was presented.[1] The objectives of the present study were to evaluate the impact of the severity of DLD on the occurrence of spinal deformity and on the choice of treatment, whether conservative or surgical
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