The Effect of Global Spinal Alignment on Cervical Degeneration in Patients with Degenerative Lumbar Scoliosis.

OBJECTIVE: To elucidate the effect of global spinal alignment on cervical degeneration in patients with degenerative lumbar scoliosis (DLS). METHODS: This study included 117 patients with DLS and 42 patients with lumbar spinal stenosis as a control group. Patients with DLS (study group) were categorized according to the Scoliosis Research Society-Schwab classification. Spinopelvic parameters were measured in cervical and full-length spine radiographs. Cervical degeneration was assessed using the cervical degeneration index (CDI) scoring system. RESULTS: There were significant differences in C2-C7 sagittal vertical axis, T1 slope, thoracic kyphosis, lumbar lordosis (LL), and pelvic tilt between DLS and control groups. Although the DLS and control groups did not differ significantly with regard to CDI scores, a striking difference was noted when sagittal spinopelvic modifiers were considered individually. Patients with a pelvic incidence (PI)-LL mismatch modifier grade of ++ had significantly higher CDI scores than patients with grade 0, and patients with a PI-LL or sagittal vertical axis modifier grade of ++ had significantly higher CDI scores than the control group. Disk narrowing scores were highest in patients with a PI-LL modifier grade of ++ followed by patients with a grade of +. Additionally, CDI scores were more associated with LL rather than cervical lordosis. CONCLUSIONS: Patients with DLS may be at greater risk of cervical spine degeneration, especially patients with a PI-LL or sagittal vertical axis modifier grade of ++. A surgical strategy for patients with DLS should be carefully selected considering the restoration of LL.

Characteristic of Paraspinal Muscle Change in Coronal Sub-type of Degenerative Lumbar Scoliosis and its Potential Clinical Significance.

OBJECTIVE: Clarifying paraspinal muscle (PM) change in degenerative lumbar scoliosis (DLS) is positive to evaluate the progression of scoliosis. This research compares the characteristic of PM change among different coronal sub-types of DLS and explores its potential clinical significance. METHODS: A total of 84 DLS patients between June 2019 to December 2021 were retrospectively analyzed. Patients were classified into three types based on the coronal balance distance (CBD): Type A, CBD <3 cm; Type B: C7 Plumb Line (C7PL) shifted to the concave side of the curve, and CBD >3 cm; Type C: C7PL shifted to the convex side of the curve, and CBD >3 cm. Fat infiltration rates in the multifidus (MS) and erector spinae (ES) at the apex of the main and fractional curves, and spinopelvic parameters were analyzed statistically. Pearson's or Spearman's correlation was applied to analyze the correlation between asymmetric degree of PM change and these parameters in three types. RESULTS: There were 62 cases with coronal sub-Type A, 6 cases with Type B, and 16 cases with Type C. Patients in Type B and C demonstrated higher fat infiltration in MS on the concave side of both the main and fractional curves when compared to those in Type A. The asymmetric degree of ES change was positively correlated with CBD at the apex of the main curve in Type B and at the apex of the fractional curve in Type C respectively, and that of MS was positively correlated with apical vertebral rotation, while negatively strong-correlated with pelvic incidence and sacral slope in Type C. CONCLUSION: PM fatty infiltration presented difference among varied coronal sub-types of DLS patients. The CBD in Type B and C patients was correlated with the asymmetric degree of ES change.

Inherited genetic predisposition and imaging concordance in degenerative lumbar scoliosis patients and their descendants.

BACKGROUND: Offspring consistently exhibit similar imaging features as their parents in cases of degenerative lumbar scoliosis (DLS). Nevertheless, the role of genetic factors in the pathogenesis of DLS remains uncertain. METHODS: A prospective analysis was conducted on 35 patients with DLS and their 36 offspring. Genomic DNA was extracted from 71 blood samples for gene mutation analysis using whole exome sequencin. Various demographic and imaging parameters were compared. RESULTS: In 11 pedigrees of the 35 family members with DLS, 13 suspected pathogenic genes were identified. Among the 35 DLS patients, 11/35(31.5%) exhibited susceptibility gene mutations (mutant group), while 24/35(68.5%) had no pathogenic gene mutations (non-mutant group). AVR was more severe in mutant group than that in no-mutant group (p < 0.05). Among the 36 offspring, 11/36(30.6%) cohorts presented susceptibility genes (mutant group), 25/36(69.4%) cohorts presented no pathogenic genes (no-mutant group). More cohorts in the mutant group presented vertebral rotation (72.8%) and scoliosis (45.5%) than those (24%), (12%) in the no-mutant group, respectively (p < 0.05). Among the 36 offspring, 8/36(22.2%) presented scoliosis (study group), they all presented the same scoliosis orientation and apex vertebrae/disc location to their parents, the other 28/36(77.8%) cohorts without scoliosis were enrolled as control group, the mutation rate (62.5%) was higher in study group than that (21.4%) in control group. CONCLUSIONS: Genetic influences are significant in the onset of DLS, with affected families showing similar scoliosis patterns and identical apex vertebrae. Moreover, individuals with genetic mutations tend to have more pronounced vertebral rotation and at a higher risk of developing scoliosis.

[RESEARCH PROGRESS OF SURGICAL SELECTION OF FUSION LEVELS FOR DEGENERATIVE SCOLIOSIS].

OBJECTIVE: To summarize the progress of the surgical selection of fusion levels for degenerative scoliosis. METHODS: The domestic and foreign related literature about degenerative scoliosis, including clinical features, classification, surgical treatment, and the fused segment, was summarized. RESULTS: Degenerative scoliosis is very complicated. Short segment fusion and long segment fusion are the main surgical types. The long segment fusion is better in terms of reconstructing the stability of spine; however, it has more related complications. The short segment fusion has been used widely in clinical, but it causes degenerative disease easily. W/AL value can be used to direct the selection of short or long segment fusion for degenerative scoliosis. CONCLUSIONS: The key to success surgery is choosing reasonable fused segment. Now there is no unified selection standard. With more knowledge about degenerative scoliosis, greater development can be expected in the future.

[CLINICAL STUDY ON MODIFIED LAMINOPLASTY WITH POSTERIOR COLUMN RESERVATION FOR TREATMENT OF LUMBAR SPINAL STENOSIS].

OBJECTIVE: To investigate the technique and effectiveness of modified laminoplasty for lumbar spinal stenosis (LSS) and to explore the application value of modified laminoplasty in maintaining the stability of the spine by comparing with the conventional laminectomy. METHODS: Fifty-six patients with LSS were included between June 2012 and July 2013, and they were divided into 2 groups: 27 patients underwent modified laminoplasty in group A, and 29 patients received conventional laminectomy in group B. There was no significant difference in sex, age, disease duration, narrow segment, visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and walking tolerance between 2 groups (P > 0.05). The postoperative VAS score of low back pain and leg pain, JOA score, walking tolerance, X-ray film, and CT were used to evaluate the clinical results. RESULTS: Dural tear occurred in 2?cases of group A and 1 case of group B and were repaired during operation. All incisions primarily healed without infection. The patients were followed up 24-31 months (mean, 24.7 months) in group A, and 24-37 months (mean, 26.2 months) in group B. The bone healing time was 6-12 months (mean, 9 months) in group A. CT showed healing at the junction of spinous process and vertebral plate in group A at 12 months after operation; new scar in varying degre es was observed in group B. At last follow-up, lumbar spondylolisthesis and instability occurred in 4?and 2 cases of group B respectively, and received re-operation. The change value of slip distance was (0.27±0.23) mm in group A and was (0.83±1.22) mm in group B, showing significant difference (t=-2.405, P=0.023). The postoperative JOA score, VAS score, and walking tolerance were significantly improved when compared with preoperative ones in 2 groups (P < 0.05).?At?last follow-up, group A was better than group B in VAS score of low back pain (P < 0.05), but no significant?difference?was?found in the other indexes between 2 groups (P > 0.05). CONCLUSIONS: The modified laminoplasty?is better than the conventional laminectomy in relieving low back pain and maintaining the stability of the lumbar spine.