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Degenerative Scoliosis


KEY FACTS

Terminology

  • Lateral curvature in spine due to degenerative disc and facet disease in older patients

  • Deformity in skeletally mature patient with Cobb angle of > 10° in coronal plane

  • Predominance of lower lumbar curves

Imaging

  • Conventional standing full-length PA and lateral radiographs for monitoring curve progression

  • Most common from L1 to L4

    • Lateral listhesis, vertebral rotation

    • Disc space loss, endplate sclerosis

    • Circumferential endplate spurring

    • Facet arthropathy

    • Spondylolisthesis, loss of lordosis

Top Differential Diagnoses

  • Adult idiopathic scoliosis

  • Neuromuscular

  • Congenital scoliosis

  • Post-traumatic, inflammatory, or neoplastic

  • Dysplasias (neurofibromatosis type 1, Marfan)

Pathology

  • Asymmetric degenerative change at multiple levels

    • Asymmetric loading of spinal segments gives 3-dimensional deformity

    • Spondylolisthesis &/or rotatory listhesis

Clinical Issues

  • Low back pain, radiculopathy

    • Pain worse with prolonged spinal extension

    • Radiculopathy not reliably relieved by flexion

      • –

        In contrast to spinal stenosis without scoliosis

  • Deformity and waist asymmetry

  • Gait disturbance

Anteroposterior radiography shows lumbar rotatory levoscoliosis (convex left) with associated multilevel marked disc height loss and endplate sclerosis
. There is left lateral listhesis of L4 on L5
.

Lateral radiography shows loss of lumbar lordosis with multilevel disc space height loss and degenerative endplate bony eburnation (sclerosis), worst at L2-L3
.

Coronal reformation of nonenhanced lumbar spine CT shows mild levoscoliosis at L4-L5 with vacuum disc phenomenon
and right-sided endplate sclerosis
. There is disc height loss at L3-L4
and L4-L5
.

Sagittal T1WI MR shows grade 1 anterolisthesis of L4 on L5
with severe disc degeneration. Degenerative discs
are also present at L2-L3 and L5-S1. Compare this to a more normal disc at L3-L4
.

TERMINOLOGY

Abbreviations

  • “De novo” scoliosis

Definitions

  • Lateral curvature in spine due to degenerative disc and facet disease in older patients

  • Deformity in a skeletally mature patient with Cobb angle of > 10° in coronal plane

    • Advanced degenerative changes and predominance of lower lumbar curves

IMAGING

General Features

  • Best diagnostic clue

    • Lateral curvature in spine with associated degenerative changes

  • Location

    • T12 to L5

      • –

        Most common from L1 to L4

    • Apex of curvature most common at L2-L3 interspace

  • Size

    • Curvature ranging from 14-80°

      • –

        Mean: 24-43°

    • Average curvature per segment < 10°

  • Morphology

    • Moderate curvature over a short spinal segment

    • Levo or dextroscoliosis

      • –

        Levoscoliosis (57-68%)

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