The Clinical Features And Radiological Analysis Of The Adult Degenerative Lumbar Scoliosis

Objective 1,Research on patients with DLS ,understand its epidemiology and cli -nical characteristics;2,Through various parameters of radiology of observation and measurement, the comprehensive evaluation of the spinal deformity, understand the location and cause of nerve compression;3,Through to DLS patients with JOA low back pain score and parameters correlation Correlation studies to determine the DLS radiological changing characteristics in patients with the JOA score and its closely related degree.Methods Based on 2011.3 -2010.2 our outpatient department and the hospital medi-cal orthopaedics 117 cases for patients with DLS study for the cross-sectional survey object, 45 patients were male, female 72 cases, aged 50-87 years, average age (64.05±9.05) years ;We collected all patients detailed medical history and physical examination,to quantify theirs neurological function and life on the ability by the Japanese Orthopaed-ic surgery Association (JOA)scoring lower back pain rating criteria,And to observe and measure theirs radiographic parameters,to statistic analysis the correlation between JOA scoring and radiological parameters, to fully evaluate the spine coronal, sagittal and axial plane deformity, understand the situation of the nerve compression。The radiograp -hic parameters include Scoliosis Cobb angle, Apical vertebral deviation, The number of scoliosis involving the vertebral body, Lumbar lordosis, Sacral angle, L3,L4 vertebrel -tilt, Apical vertebral rotation and so on.Results 1,DLS patients in 117 cases, of which 103 patients associated with basic diseases, accounting for 88%, basic diseases more common in the Cardiovascular systemEndocrine system,Respiratory system,Urinary system,Osteoarthritis,Rheumatoid arthri-tis and other diseases, and the majority of patients see more of basic diseases coexist;2,Clinical characteristics :102 patients complained of low back pain, accounting for 95.7%, men 42 patients, 60 cases of female patients, The history of low back pain ranging from one months to 30 yeas;Patients with lower extremity radicular symptoms in 65 cases, 98 nerve root involved, Affected nerve root with concave side common, convex side nerve root radiation pain than concave side (78%), and with the L5,S1 primarily。Some of these patients showed only bilateral or unilateral hip pain numb,nothave lower limb radiation pain;7 patients with mild urinate dysfunction lawsuit, 2 pati -ents had obvious incontinence ;69 cases of patients with intermittent claudication, 31 patients were male and 38 females, the pain reflected in the double lower limbs in 23 cases and 35 alternate single-limb Cases, one limb in 11 cases;3,This group of patients,the prevalence rate of male: female = 1:1.6; 82 cases (70.1%) convex to the left, 35 cases (29.9%) convex to the right; different sex in bending direction no significant diff -erence(χ2=0.050, P=0.823﹥0.05);4,Lumbar scoliosis vertebral in X-ray films char -acteristic:range of 3-6 vertebral scoliosis, scoliosis cumulative average of 4.6 vertebrae;Coronal Cobb angle of 10.2°-24.3°,the average (14.38±2.88)°; Lumbar lordosis -8.3°-66.2°,the average (30.24±11.96)°; Sacral angle of 9.2°-65.6°, the average (31.02±9.50)°;Apical vertebra distribution to L3,L4mainly ,Lateral sliding in L2,L3 vertebral primarily ; Apical vertebral deviation degree 0.03-0.68, the average (0.23±0.11); Apical vertebral rotation to gradeⅠ,Ⅱdegree mostly;5,Nerve root compression characteristics:In the lumbar scoliosis concave side to L2,L3,L4 nerve roots common, convex side of the L5,S1 nerve root common;Nerve root compression reason in lumbar scoliosis convex side and concave side were already Joint degeneration hyperplasia, Ligamentum flavum hypertrophy calcification;6,The JOA score and The radiological parameters of the correlation:The lumbar lordosis Angle, sacral angle, L3,L4 vertebral inclination, vertebral rotation degree and vertebral lateral sliding have correlated with The JOA.Conclusion 1,The DLS patients with complex disease, most of all mergers of chronic system disease;Within the scope of scoliosis often accompanied by osteoporosis and vertebral compression fractures is a cause of fracture patient waist pain symptom aggravating, accelerate the Cobb Angle increased reason;2,L2,L3,L4 nerve root compression is common in lumbar scoliosis concave side,L5,S1 nerve root compressio-nis common in lumbar scoliosis convex side;Facet joint proliferation and degeneration, Ligamentum flavum hypertrophy calcification, Disc collapse often leads to nerve root compression;3,The lumbar lordosis, Sacral angle, The L3,L4 vertebral inclination, vertebral rotation degree and vertebral lateral sliding have correlation with The JOA.The separameters are important to the JOA score was more reliable evaluation of clinical performance indicators.