Classification and Treatment of Degenerative Lumbar Spinal Deformity

Jun-Young Yang; June-Kyu Lee; Dong-Hee Kim; Se-Min Woo; Sung-Hwan Ahn; Ho-Sup Song

doi:10.4184/jkss.2006.13.4.247

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Yang, Lee, Kim, Woo, Ahn, and Song: Classification and Treatment of Degenerative Lumbar Spinal Deformity

Original Article

Journal of Korean Spine Surg 2006;13(4):247-254.

Published online: 21 February 2006

DOI: https://doi.org/10.4184/jkss.2006.13.4.247

Classification and Treatment of Degenerative Lumbar Spinal Deformity

Jun-Young Yang, M.D., June-Kyu Lee, M.D., Dong-Hee Kim, M.D., Se-Min Woo, M.D., Sung-Hwan Ahn, M.D., Ho-Sup Song, M.D.

Department of Orthopedic Surgery, School of Medicine, Chungnam National University, Daejeon, Korea

Address reprint requests to Jun Young, M.D. Department of Orthopedic Surgery, School of Medicine, Chung Nam National University #640 Daesa-Dong Jung-Gu Dae Jeon, Korea, Tel: 82-42-220-7351, Fax: 82-42-252-7098, E-mail: jyyang@cnu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study

Objective

To categorize and analyze clinical results of degenerative lumbar deformity patients according to the degree of scoliosis and kyphosis.

Summary and Literature Review

A degenerative spinal deformity is classified into a coronal and sagittal deformity. There are some reports about treatment according to each classification but the classification is sometimes inappropriate and the treatment can vary.

Materials and Methods

From June 1998 to June 2003, 79 patients, who were diagnosed with a degenerative lumbar deformity and underwent conservative or operative treatment, were studied retrospectively. Group I had scoliosis ranging from 10 to 20。, and group II had scoliosis �20。 Each group was subdivided into A, B, and C according to the lordosis, group A �30。, group B between 20 to 30。, and group C �20。. Scoliosis and lordosis were measured from the radiographs and the clinical results were evaluated using the Kirkaldy-Willis criteria and VAS score before and after surgery.

Results

In group I, 9 cases underwent surgery and 11 cases underwent conservative treatment, without any significant differences in the clinical results. In group II, 35 cases underwent surgery and 24 cases underwent conservative treatment. Excellent results were obtained in 18(51.4%) cases, good in 15(42.9%) and 2(5.7%) were below fair. The average VAS score in group II given conservative treatment 8.9 preoperatively and 6.5 at the final follow up. Tn group II given surgical treatment the average VAS score was 9.2 preoperatively and 4.1 at the final follow up. There was a significant difference in the outcome (P�0.05).

Conclusion

Patients with a degenerative lumbar deformity with accompanying lumbar scoliosis and kyphosis, scoliosis �20。 or lordosis �20。 are expected to show more improvement in symptom after surgery than after conservative treatment.

Keywords: degenerative lumbar deformity, scoliosis, kyphosis

REFERENCES

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Figures and Tables%

Fig. 1.

Correction of kyphotic angle of the operative group. IIC group show maximal correction.

Fig. 2.

Changes of kyphotic angle of the nonoperative group. IIA group had progressed to the IIC group level and IIB group also had progressed to the IIC group level.

Fig. 3.

Correctioin of scoliotic angle of the operative group. IIC group show maximal correction.

Fig. 4.

Changes of scoliotic angle of the nonoperative group. IC group had progressed to the II group level.

Fig. 5.

The case of conservative Treatment. (A) Initial AP and lateral radiographs. The Cobb's angle was 15 degree and lordotic angle was 18 degree and this case was classified into group IC. (B) The radiographs of 2 years follow up. The Cobb's angle increased up to 25 degree and lordotic angle decreased to 9 degree.

Fig. 6.

The case of long spinal fusion. (A) Initial AP and lateral radiographs. The Cobb's angle was 28 degree and lordotic angle was 21 degree and this case was classified into group IIB. (B) The radiographs of 2 years follow up. The Cobb's angle decreased to 13 degree and lordotic angle increased to 34 degree.

Table 1.

Data of Each Group

Group		I			II
Subgroup	A	B	C	A	B	C
Conservative Tx.	3	4	4	12	5	7
Operative Tx.	1	3	5	14	4	17

Table 2.

Correction of Kyphotic Angle of the Operative Group

Group		Pre-operation	Postoperation	Last follow up
	A	31	32	29
I	B	21.5	31.2	28.4
	C	16.2	31.3	26.9
	A	32.3	37.3	35.1
II	B	21.1	36.5	34.6
	C	4.2	35.1	34.4

Table 3.

Changes of Kyphotic Angle of the Nonoperative Group

Group		Initial	Last follow up
	A	36.3	23.8
I	B	23.1	13.5
	C	17.4	8.9
	A	31.1	17.5
II	B	22.1	7.8
	C	14.3	4.1

Table 4.

Correction of Scoliotic Angle of the Operative Group

Group		Pre-operation	Postoperation	Last follow up
	A	12	5	6
I	B	13.5	7.2	7.8
	C	15.3	7.9	8.1
	A	21.6	11.2	12.8
II	B	28.2	12.2	13.5
	C	38.7	13.5	13.9

Table 5.

Changes of Scoliotic Angle of the Nonoperative Group

Group		Initial	Last follow up
I	A	11.5	17.2
	B	12.3	19.8
	C	13.8	25.1
II	A	21.2	28.6
	B	23.5	30.1
	C	26.7	34.8

Table 6.

Clinical Results of Operative Group by Kirkaldy-Willis Criteria

Group		I			II
Subgroup	A	B	C	A	B	C
Excellent	0	1	2	6	3	9
Good	1	1	2	7	1	7
Fair	0	1	1	1	0	0
Poor	0	0	0	0	0	1

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