Do Curve Characteristics Influence Stenosis Location and Occurrence of Radicular Pain in Adult Degenerative Scoliosis?

Abstract

Study design. Retrospective cohort Objective. The aim of this study was to describe the various locations of spinal stenosis (LSS) in lumbar scoliosis (DLS) and its related clinical symptoms. Introduction. Adult with lumbar scoliosis often present with pain and disability. Association of scoliosis and stenosis is not rare, but remains sparsely explored. Consequences of scoliosis on stenosis location and treatment remain debated. Methods. Patients operated for symptomatic LSS with DLS (Cobb angle>20°) from 2015 to 2016 were included. All patients completed preoperative clinical and neurologic exam. Coronal and sagittal radiographic parameters, rotatory subluxation (RS) and spondylolisthesis were analyzed on fullspine x-rays. CT-scan multiplanar reconstructions were performed to measure central, foraminal and lateral recess stenosis stenosis, from T10 to Sacrum.Results. 76 patients were included (69±9 years old, 77% female). 60% had neurogenic claudication, L5 was the most common radicular pain (41%). Mean Cobb angle was 33±16°. 35 (46%) patients had coronal malalignment; in 69%, side of the coronal tilt corresponded to side of the concavity of the lumbosacral curve. 60 patients had RS (most frequent level L3L4). In 50% of the cohort, RS was located at junction between lumbar and lumbosacral curves. In 70% (n=53) of the patients, central stenosis occurred at junction between lumbar and lumbosacral curve. Foraminal and lateral stenosis were most frequently observed in the concavity of the distal lumbo-sacral curve. L5 radicular pain was significantly more frequent in case of lumbo-sacral contra-curve and right coronal malalignment.Conclusion. LSS is frequent in DLS. Relationships exist between curve characteristics and symptomatic LSS in DLS; especially, concavity of the lumbosacral contra-curve and the junctional level between lumbar curve and lumbosacral contra-curve and. Therefore, accurate analysis of stenosis in ASD seems mandatory, to at least performed decompression; since, perfect planned treatment for stenosis and scoliosis correction might not be always performed, due to patient general health status.Level 4

Conservative Treatment of Degenerative Lumbar Scoliosis

“…Central spinal stenosis is generally seen at the junction between two curves. In the study by Ferrero et al [39], 70% of the cohort had central stenosis at the junction between the main lumbar curve and the lumbosacral hemicurve. Central spinal stenosis also occurs in the concavity of the main lumbar curve and at the junction between the main thoracic curve and the lumbar curve [39].…”

“…When present, it causes contralateral lateral recess and foraminal Spinal Deformities in Adolescents, Adults and Older Adults DOI: http://dx.doi.org /10.5772/intechopen.90052 stenosis. Closed dislocation, on the other hand, is generally seen on the concavity of the curve, causing an ipsilateral pattern of stenosis [38,39]. L1 and L2 are the most frequently involved [38].…”

“…In a study of a cohort of 78 patients with DLS and spinal canal stenosis, Ferrero et al [39] demonstrated that foraminal and lateral stenosis were most frequently observed on the concavity of the distal lumbosacral curve. L5 radicular pain was significantly more frequent in the presence of compensatory lumbosacral hemicurve [39].…”

“…It is interesting to note that the side of radicular pain frequently corresponded to the side of coronal shift. Patients with right truncal coronal shift more frequently present with right radicular pain; similarly, patients with left coronal shift more commonly present with left radicular pain [39]. The mechanism involved was not clear, though it was found that in 69% of the cases, the truncal coronal shift was associated with the side of the lumbosacral counter-curve (i.e., C7 is shifted to the convex side of the main lumbar curve) [39].…”

“…With progression of the condition, vertebral instability in the form of a translatory shift may be evident [39]. Very often, lateral vertebral translation or laterolisthesis is accompanied by vertebral rotation, when it is known as VRO.…”