ABSTRACT

The objective of this cross-sectional radiological study was to analyze the degenerative process in the lumbar spine in patients with and without scoliosis, in order to determine potential risk factors, which may be related to the development of de novo scoliosis. In 121 adults (≥50 years), analyzed radiological parameters included: listhesis, wedging, and height of each lumbar vertebra, wedging and height of each disc, length of vertebral spurs, lumbar lordosis, lumbosacral, lumbo (L5) horizontal and sacro-horizontal angles, pelvic tilt on A-P X-ray, depth of L5 from the intercrest line, also -if present- pattern of curve, and level presenting with the most obvious degenerative changes (MODC). Uni- and multi-variate statistical tests were used for analysis. Degenerative changes were most obvious in the middle lumbar region. MODC at the L2 vertebra/L2-3 disc and L4 vertebra/L4-5 disc levels were more frequent in cases with scoliosis (p=0.013, p=0.022, respectively). Upon multivariate analysis the presence of scoliosis was closely related to the presence of lateral listhesis of L3, wedging of L3-4 disc, or pelvic tilt (p=0.000, p=0.000, p=0.001, respectively). Cases with MODC at the L3-4 disc level, or a more cranial apex of curve had a higher degree of scoliosis (p=0.009, p=0.017, respectively). Whereas, MODC at the L5-S1 level coexist with a low degree or no scoliosis (p=0.009). Degenerative changes in the middle lumbar region, and pathologic conditions in the hip or lower extremities resulting in pelvic tilt, are frequent findings in cases with de novo scoliosis. Likewise, asymmetric degenerative changes at the L3-4 disc level, and a more cranial apex of curve, were associated with an increased scoliotic curve. However, degenerative changes at the L5 vertebra/L5-S1 disc level carries lower risk in producing scoliosis.