Introduction: Spine surgeons correlate clinical presentation with radiographic findings in a patient-tailored approach.
Despite the prevalence of adult degenerative scoliosis (ADS), there are few radiographic markers to predict presence of
radiculopathy. Emerging data suggest that spondylolisthesis, obliquity, foraminal stenosis and curve-concavity may be
associated with radiculopathy in ADS. The purpose of this study was to determine if radiculopathy in ADS is associated
with reduced interpedicular heights (IPHs) measured on routine radiographs.
Methods: Retrospective chart review was performed in ADS patients referred to scoliosis surgeons. Inclusion criteria included patients with ADS and no prior thoracolumbar-surgery. Data were collected from initial spine surgeon clinic notes and radiographs. Clinical outcome data included presence, side(s) and level(s) of radiculopathy; presence of motor deficits; and presence of sensory deficits. Variables included age, gender, Scoliosis Research Society-30 (SRS-30) and Oswestry Disability Index (ODI) questionnaire data, and radiographic measurements. Radiographic measurements included Cobb angles and L1 to S1 IPHs on upright and supine radiographs. Associations were assessed with univariate and multivariate statistical analyses.
Results: Average age of patients that met inclusion criteria was
51-years. Increased age was associated with radiculopathy, weakness and sensory deficits. Patients that were 55-years or older were approximately 8 times more likely to have a radiculopathy, 5 times more likely to have a motor deficit, and 5 times more likely to have a sensory deficit than those younger than 55. Caudally-located nerve roots are more likely to develop radiculopathy. Motor deficits were associated with worse SRS-30 functional and ODI scores, but radicular pain and sensory deficits were not associated with lower SRS-30/ODI scores. Finally, radiculopathy was associated with reduced IPH in both supine and upright radiographs.
Conclusions: Radiculopathy in ADS patients is associated with reduced IPHs and increased age. Measuring IPHs on routine radiographs may be helpful in associating clinical radiculopathy with radiographic measures to guide patient management and surgical planning.
Patient Care: Results with impact patient assessment and operative planning.
Learning Objectives: Association between interpedicular heights and radiculopathy.