Analysis of degeneration degree in the main curvature region of degenerative scoliosis

doi:10.12307/2025.181

Abstract

Abstract: BACKGROUND: The pathogenesis of degenerative scoliosis is unclear, and asymmetric degeneration of the main curvature region may be strongly associated with the onset and progression of scoliosis. Fully recognizing the degeneration of the main curvature region can help to inform more clinical treatment strategies.

OBJECTIVE: To explore the relationship between the degree of degeneration in the main curvature region and the parameters of the spinal pelvis in patients with degenerative scoliosis and to understand its pathogenesis.

METHODS: The medical records and imaging data of patients with degenerative scoliosis admitted to Department of Spine Surgery, Affiliated Hospital of Southwest Medical University from July 2018 to November 2023 were collected. The difference in the facet joint osteoarthritis between concave and convex sides of the superior and inferior facet joints of the apical vertebra was compared to analyze the correlation between parameters such as the severity of scoliosis, spinopelvic parameters, and facet joint osteoarthritis and to explore the influencing effect between parameters such as the severity of scoliosis, spinopelvic parameters, and facet joint osteoarthritis.
RESULTS AND CONCLUSION: (1) Among the facet joint of the apical vertebra, concave side was more severe than convex side with facet joint osteoarthritis, with a statistically significant difference (P < 0.001). On the same side (concave or convex side) of the apical vertebra superior facet joint osteoarthritis was more severe than inferior facet joint osteoarthritis, with a statistically significant difference (P < 0.001). (2) The pelvic incidence decreased with decreasing lumbar lordosis (rs=0.509, P < 0.001). The lateral osteophyte difference increased with decreasing lumbar lordosis (rs=-0.285, P=0.033). The facet joint tropism increased with decreasing pelvic incidence (rs=-0.379, P=0.004). (3) The L5 tilt angle and disc angle were risk factors for increased main curve Cobb angle (B=1.012, P < 0.001; B=0.620, P=0.016). Pelvic incidence was a protective factor against the increase of the main curve Cobb angle (B=-0.264, P=0.003). (4) It is concluded that in cases of degenerative scoliosis, the degree of degeneration on the concave side was significantly heavier than that on the convex side at the apical vertebra. There was no significant correlation between the severity of facet joint tropism and facet joint osteoarthritis and the severity of scoliosis. Lumbar lordosis and pelvic incidence played key roles in maintaining the normal spinal sequence. Pelvic incidence was a protective factor against the increase of the main curve Cobb angle. L5 tilt angle and disc angle were the risk factors for the increase of the main curve Cobb angle.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: degenerative scoliosis, main curvature region, apical vertebra, asymmetric degeneration, facet joint osteoarthritis

CLC Number:

Wang Minglang, Jiang Lin, Song Bin, Zhang Li, Zhang Qiang, Feng Daxiong. Analysis of degeneration degree in the main curvature region of degenerative scoliosis[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(15): 3206-3214.

Figures/Tables 5

References

[1] PLOUMIS A, TRANSFLEDT EE, DENIS F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J. 2007;7(4):428-436.
[2] DIEBO BG, SHAH NV, BOACHIE-ADJEI O, et al. Adult spinal deformity. Lancet. 2019;394(10193):160-172.
[3] 张科峰,刘阳,张存鑫,等.退变性腰椎侧凸的认知及矫形融合固定治疗[J]. 中国组织工程研究,2019,23(32):5227-5232.
[4] TOMÉ-BERMEJO F, PIÑERA AR, ALVAREZ-GALOVICH L. Osteoporosis and the Management of Spinal Degenerative Disease (I). Arch Bone Jt Surg. 2017;5(5):272-282.
[5] KOBAYASHI T, ATSUTA Y, TAKEMITSU M, et al. A prospective study of de novo scoliosis in a community based cohort. Spine. 2006;31(2):178-182.
[6] FUJIWARA A, TAMAI K, AN HS, et al. The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord. 2000;13(5):444-450.
[7] MURATA Y, TAKAHASHI K, HANAOKA E, et al. Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar scoliosis. Spine. 2002;27(20):2268-2273.
[8] AEBI M. The adult scoliosis. Eur Spine J. 2005;14(10):925-948.
[9] SCHOUTENS C, CUSHMAN DM, MCCORMICK ZL, et al. Outcomes of Nonsurgical Treatments for Symptomatic Adult Degenerative Scoliosis: A Systematic Review. Pain Med. 2020;21(6):1263-1275.
[10] HEY HWD, KIM CK, LEE WG, et al. Supra-acetabular line is better than supra-iliac line for coronal balance referencing-a study of perioperative whole spine X-rays in degenerative lumbar scoliosis and ankylosing spondylitis patients. Spine J. 2017;17(12):1837-1845.
[11] KITANAKA S, TAKATORI R, ARAI Y, et al. Facet Joint Osteoarthritis Affects Spinal Segmental Motion in Degenerative Spondylolisthesis. Clin Spine Surg. 2018;31(8):E386-E390.
[12] CHO KJ, KIM YT, SHIN SH, et al. Surgical treatment of adult degenerative scoliosis. Asian Spine J. 2014;8(3):371-381.
[13] SUN XY, KONG C, ZHANG TT, et al. Correlation between multifidus muscle atrophy, spinopelvic parameters, and severity of deformity in patients with adult degenerative scoliosis: the parallelogram effect of LMA on the diagonal through the apical vertebra. J Orthop Surg Res. 2019;14(1):276.
[14] RICHARDSON CA, JULL GA. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995;1(1):2-10.
[15] 喻学科,陈灿,李凯,等.退行性腰椎侧凸与多裂肌退变的关联性研究[J]. 陆军军医大学学报,2022,44(20):2075-2081.
[16] 苏少亭,周红海,侯召猛,等.腰椎定点旋转手法操作中拇指推力的有限元分析[J]. 中国组织工程研究,2024,28(12):1823-1828.
[17] 高飞,赵斌.腰椎关节突关节基础研究新进展[J]. 医学影像学杂志, 2009,19(7):925-927.
[18] VARLOTTA GP, LEFKOWITZ TR, SCHWEITZER M, et al. The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skeletal Radiol. 2011;40(1):13-23.
[19] KE S, HE X, YANG M, et al. The biomechanical influence of facet joint parameters on corresponding segment in the lumbar spine: a new visualization method. Spine J. 2021;21(12):2112-2121.
[20] ROESSINGER O, HÜGLE T, WALKER UA, et al. Polg mtDNA mutator mice reveal limited involvement of vertebral bone loss in premature aging-related thoracolumbar hyperkyphosis. Bone Rep. 2022;17:101618.
[21] KITA N. Ultrastructural studies of articular cartilaginous degeneration in the facet joints in spinal scoliosis. Nihon Seikeigeka Gakkai Zasshi. 1994; 68(4):184-195.
[22] YASUDA H, MATSUMURA A, TERAI H, et al. Radiographic evaluation of segmental motion of scoliotic wedging segment in degenerative lumbar scoliosis. J Spinal Disord Tech. 2013;26(7):379-384.
[23] DE VRIES AA, MULLENDER MG, PLUYMAKERS WJ, et al. Spinal decompensation in degenerative lumbar scoliosis. Eur Spine J. 2010; 19(9):1540-1544.
[24] 郑杰,杨永宏.椎间盘和关节突关节在退变性脊柱侧凸发生发展中的作用[J]. 中国脊柱脊髓杂志,2018,28(9):826-831.
[25] 林云飞,王飞,李放.导致腰椎峡部裂的风险因素研究现状[J]. 脊柱外科杂志,2016,14(3):181-184.
[26] LAFAGE V, SCHWAB F, PATEL A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine. 2009;34(17):E599-E606.
[27] BOURRET S, CERPA M, KELLY MP, et al. Correlation analysis of the PI-LL mismatch according to the pelvic incidence from a database of 468 asymptomatic volunteers. Eur Spine J. 2022;31(6): 1413-1420.
[28] LI J, XIAO H, JIANG S, et al. Risk Factors and Three Radiological Predictor Models for the Progression of Proximal Junctional Kyphosis in Adult Degenerative Scoliosis Following Posterior Corrective Surgery: 113 Cases With 2-years Minimum Follow-Up. Global Spine J. 2023;13(8): 2285-2295.
[29] SIMMONS ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res. 2001;(384): 45-53.
[30] 丁文元,申勇,曹来震,等.腰椎退变性侧凸患者椎间盘退行性变的影像学观测[J]. 中国脊柱脊髓杂志,2010,20(8):673-676.
[31] 周仕炼,胡星新,杨曦,等.退变性腰椎侧凸六种工况运动下的生物力学的有限元分析[J]. 华西医学,2018,33(9):1099-1105.
[32] SEO JY, HA KY, HWANG TH, et al. Risk of progression of degenerative lumbar scoliosis. J Neurosurg Spine. 2011;15(5):558-566.
[33] ZHANG J, WANG Z, CHI P. Risk Factors for Immediate Postoperative Coronal Imbalance in Degenerative Lumbar Scoliosis Patients Fused to Pelvis. Global Spine J. 2021;11(5):649-655.
[34] LEWIS SJ, KESHEN SG, KATO S, et al. Risk Factors for Postoperative Coronal Balance in Adult Spinal Deformity Surgery. Global Spine J. 2018;8(7):690-697.
[35] SWAMY G, BERVEN SH, BRADFORD DS. The selection of L5 versus S1 in long fusions for adult idiopathic scoliosis. Neurosurg Clin N Am. 2007; 18(2):281-288.