Degenerative Scoliosis

Definition

 

Lateral deviation of the spine that develops after the age of 50

- minimal structural vertebral deformity

 

Lower lumbar

- convex left

 

Aetiology

 

Unknown

- only very weak links to osteoporosis and degenerative disc disease

 

NHx

 

Progression

- larger curves > 30^o

- increased rotation

- lateral lithesis > 6mm

- inter-crest line through or below L4/5 space

 

Larger curves more likely to have pain

 

Symptoms

 

LBP

 

Neurogenic claudication

 

Radiculopathy

- nerve roots compressed in concavity

 

X-ray

 

 

MRI

 

Myelopathy

 

Decreased height of nerve foramina

 

 

Management

 

Non Operative

 

Epidural Steroids

 

Operative 

 

Technique

 

Multilevel decompression and posterior instrumented fusion

- laminectomy / foraminotomy

- +/- interbody cages to increase foraminal size

 

Deformity correction rare