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Basic Degenerative Lumbar Scoliosis

  • Sebastian HartmannEmail author
  • Anja Tschugg
  • Claudius Thomé
Chapter

Abstract

Degenerative lumbar scoliosis (DLS) or “de novo scoliosis” represents a pathological condition associated with rotational subluxation and anteroposterior or lateral olisthesis leading to coronal deformity. DLS is defined as a coronal Cobb angle of more than 10° but rarely exceeding 50°. The etiological progress is multifactorial and still unclear but starting with intervertebral disc degeneration, facet joint degeneration and changes in canal as well as pedicle morphology. The scoliotic curve typically develops in the fifth decade of life and is not based on idiopathic adolescent scoliosis (AIS). Life time prevalence is between 8–13% increasing with age, so that the prevalence in the sixth decade of life rises up to 60% with women being more frequently affected than men. In contrast to patients with AIS, the clinical symptomatology in DLS patients is usually characterized by low back pain, neurogenic claudication associated with neurological deficits in the lower extremities and rarely cauda equina syndrome. The spinal deformity shows a mean annual curvature progression in the coronal plain of 3–4°, although the progression does not translate linearly, so that the prognosis which curve is progressing cannot be reliably predicted. Nevertheless, the literature provides evidence, that increased intervertebral disc degeneration, lateral translation >6 mm and an intercrest line through the L5 vertebra may be considered as progression factors of these coronal deformities. The majority of DLS show an accompanied segmental kyphosis resulting in moderate or severe sagittal imbalance. As a result, a classification system of degenerative disc disease based on the distribution of the diseased segments and the balance status of the spine has been generated to guide the treatment of DLS. Therefore, the treatment of DLS patients is characterized by a wide variability of surgical options ranging from simple lumbar nerve root decompression to complex thoracolumbar fusions with sagittal deformity corrections. The surgical treatment is even more complex due to the accompanied comorbidities associated with the increased age in DLS patients.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sebastian Hartmann
    • 1
    Email author
  • Anja Tschugg
    • 1
  • Claudius Thomé
    • 1
  1. 1.Department of NeurosurgeryMedical University InnsbruckInnsbruckAustria

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