Authors: Sayf S A Faraj Roderick M Holewijn Miranda L van Hooff Marinus de Kleuver Ferran Pellisé Tsjitske M Haanstra
Publish Date: 2016/05/24
Volume: 25, Issue: 8, Pages: 2347-2358
Abstract
Studies were selected for inclusion following a systematic search in the bibliographic databases PubMed and EMBASE prior to September 2015 and hand searches of the reference lists of retrieved articles Two authors independently assessed methodological quality Data were extracted and presented according to a best evidence synthesisThe literature search generated a total of 2696 references After removing duplicates and articles that did not meet inclusion criteria 12 studies were included Due to the lack of statistical analyses pooling of data was not possible Strong evidence indicates that increasing intervertebral disk degeneration lateral vertebral translation ≥6 mm and an intercrest line through L5 rather than L4 are associated with DNDLS curve progression Moderate evidence suggests that apical vertebral rotation Grade II or III is associated with curve progression For the majority of other prognostic factors we found limited conflicting or inconclusive evidence Osteoporosis a coronal Cobb angle 30° lumbar lordosis lateral osteophytes difference of ≥5 mm and degenerative spondylolisthesis have not been shown to be risk factors Clinical risk factors for progression were not identifiedThis review shows strong evidence that increased intervertebral disk degeneration an intercrest line through L5 and apical lateral vertebral translation ≥6 mm are associated with DNDLS curve progression Moderate evidence was found for apical vertebral rotation Grade II/III as a risk factor for curve progression These results however may not be directly applicable to the individual patientThe Global Burden of Disease Study has shown that low back pain has remained the leading cause for years lived with disability YLD in Western societies in the last two decades 1 With its lifetime prevalence between 58 and 84 low back pain poses substantial burden on global health care 2 3 4 A large proportion 85 of low back pain is nonspecific and has an unknown aetiology 5 Of the remaining group one of the known causes for low back pain is scoliosis a lateral and rotational deformity of the spine with a Cobb angle of more than 10° in the coronal plain 6 7 Primary degenerative scoliosis or de novo degenerative lumbar scoliosis DNDLS is a condition in which a lumbar scoliotic curve typically develops after the age of 50 in patients who did not have a childhood scoliosis 7 8 DNDLS causes an increasing burden on society in aging populations with reduction in health related quality of life due to severe back and leg pain 9 10 The aetiology of DNDLS is multifactorial including genetic predisposition and intervertebral disk degeneration 11 12 13 14 15 Several studies have reported prevalence rates of 83 89 and 133 for adult scoliosis 16 17 18 There is sufficient evidence to assume that the growing elderly population will result in an increase in prevalence rates of adult scoliosis 19 20 21 22DNDLS can cause back and leg pain symptoms in patients without a history of adolescent idiopathic scoliosis AIS and is radiologically characterized by a Cobb angle of 10° or more and by asymmetrical disk and/or facet arthritis 7 23 24 25 26 27 In DNDLS to date curve progression is unpredictable Weinstein and Ponseti 1983 showed that 68 of curves in AIS as well as adult scoliosis progressed more than 5° after skeletal maturity 28 In addition they demonstrated that the progression rate in adult scoliosis is much higher in comparison with AIS Little else is known about curve progression in DNDLS and prognostic factors are still undefined Estimating the risk of curve progression is essential for health care providers to be able to adequately inform patients and to determine the optimal timing for therapeutic interventions
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