Adult Degenerative Scoliosis: Evaluation and Management

Fernando E. Silva, M.D.; Lawrence G. Lenke, M.D.


Neurosurg Focus. 2010;28(3):E1 

In This Article

Radiographic Evaluation

Full-length standing anteroposterior and lateral radiographs are obtained.[22] Supine long cassette radiographs—removing gravity from the trunk—are obtained if operative intervention is planned, as these images quickly show the degree of correction spontaneously occurring. These curves typically have an L2–3 apex and are associated with lateral olisthesis, rotatory subluxation, and minimal structural vertebral deformity. They tend to have lumbar hypolordosis and short reciprocating curves without significant scoliosis above the lumbar levels. A fractional curve, L-4 to the sacrum, is also typically evident (Fig. 1). Computed tomography myelograms and MR images are also obtained. The former are particularly useful in this older age group, as some patients cannot undergo MR imaging studies because of cardiac pacemaker placement. Provocative testing helps to elucidate the pain generators, which can include facet/nerve root blocks and discograms. Such testing helps to further determine whether the structural deformity and/or the other pathologies are the primary pain generators, which in turn helps to determine the necessary portions of pathology that should be addressed, would best relieve the patient's symptoms, and produce a successful clinical outcome.[15] Appropriate Cobb angle measurements as well as the parameters of spinopelvic balance are calculated for surgical planning. In this group of patients, sagittal balance is of the utmost importance as it has been correlated with successful clinical outcomes.[16] Additionally, the degree of rotatory subluxation and olisthesis is quantified, and osteophytes are noted.[22] The latter is crucial in terms of radiographic mechanical stability and helps in planning the type of operative intervention required for a given patient.

Figure 1.

Radiograph demonstrating features of fractional degenerative lumbar scoliosis.