Original Research
Risk of Progression in De Novo Low-Magnitude Degenerative Lumbar Curves: Natural History and Literature Review
Am J Orthop. 2009 August;38(8):404-409
Author and Disclosure Information
Kingsley R. Chin, MD, Christopher Furey, MD, and Henry H. Bohlman, MD
Dr. Chin is a spine surgeon with the Institute for Minimally Invasive Spine Surgery (iMIS), West Palm Beach, Florida.
Dr. Furey is Assistant Professor of Orthopaedics, and Dr. Bohlman is Professor of Orthopaedics, Spine Institute, Case Western Reserve University Medical School, Cleveland, Ohio.
Natural history studies have focused on risk for progression in lumbar curves of more than 30°, while smaller curves have little data for guiding treatment. We studied curve progression in de novo degenerative scoliotic curves of no more than 30°.
Radiographs of 24 patients (17 women, 7 men; mean age, 68.2 years) followed for up to 14.3 years (mean, 4.85 years) were reviewed. Risk factors studied for curve progression included lumbar lordosis, lateral listhesis of more than 5 mm, sex, age, convexity direction, and position of intercrestal line.
Curves averaged 14° at presentation and 22° at latest follow-up and progressed a mean of 2° (SD, 1°) per year. Mean progression was 2.5° per year for patients older than 69 years and 1.5° per year for younger patients. Levoscoliosis progressed 3° per year and dextroscoliosis 1° per year (P<.05). Forty-six percent of patients had lateral listhesis of more than 5 mm at L3 and L4.
Curve progression was not linear and might occur rapidly, particularly in women older than 69 with lateral listhesis of more than 5 mm and levoscoliosis. Small curves can progress and therefore should be individualized in the context of other risk factors.