Adult Scoliosis: A Quantitative Radiographic and Clinical Analysis

Abstract

STUDY DESIGN: Prospective analysis of a consecutive series of adult patients with adolescent idiopathic scoliosis of the adult and de novo degenerative scoliosis. OBJECTIVES: To clinically and radiographically study two populations of adult patients with either adolescent idiopathic scoliosis of the adult or de novo degenerative scoliosis in a quantitative manner to identify reliable radiographic parameters that correlate with clinical symptoms. SUMMARY AND BACKGROUND: Although there are many causes of spinal deformity in the adult, there are two main categories of adult scoliosis: adolescent idiopathic scoliosis of the adult and de novo degenerative scoliosis. Unlike pediatric scoliosis, in adults there are no established radiographic parameters or classification systems that reliably provide a clinical correlation or offer a useful language for communication among specialists. This study gathered complete clinical and radiographic information on 95 patients with adult scoliosis and established several radiographic parameters that correlated with clinical symptoms. METHODS: Each of the 95 patients completed a clinical questionnaire that included a self-reported visual analog scale and underwent full-length standing anteroposterior and lateral radiography. Radiographic analysis was performed by use of digital analysis and included measurement of the Cobb angle, the number of vertebrae in each curve, plumbline offset from T1 to the midsacral line, the upper endplate obliquities of L3 and L4, and maximal lateral olisthy between two adjacent lumbar vertebrae. Sagittal plane measurements included lumbar lordosis, thoracolumbar kyphosis, and the Sagittal Pelvic Tilt Index. Statistical analysis of both radiographic and clinical parameters of pain was performed to determine any significant correlations between the two. RESULTS: This study showed that lateral vertebral olisthy, L3 and L4 endplate obliquity angles, lumbar lordosis, and thoracolumbar kyphosis were significantly correlated with pain. CONCLUSION: This quantitative analysis identified several clinically relevant radiographic parameters in adult scoliosis patients. Additionally, excellent predictive formulas for self-reported pain levels were obtained.