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Figure A
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Figure B
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Figure C
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Figure D
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Figure E
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The patient has adult degenerative scoliosis. The radiographic parameter that most strongly correlates with visual analog pain scores and disability is thoracolumbar kyphosis. Sagittal spinal deformity is a known cause of significant pain and disability. With increasing kyphosis, sagittal alignment becomes positive, and patients experience abnormal spinal loads and compensatory postural changes that cause clinical symptoms. Radiographic increase in thoracolumbar kyphosis is causative of disability in this clinical setting. Schwab et al. evaluated adults with idiopathic scoliosis and de novo degenerative scoliosis, looking for radiographic parameters that correlated with clinical symptoms. They found that decreasing lumbar lordosis and increasing thoracolumbar kyphosis significantly correlated with worse visual analog pain scores. Glassman et al. correlated radiographic spinal deformity parameters with disability indices including the SF-36, Scoliosis-Research-Society-29, and the Oswestry Disability Index (ODI). The authors found that positive sagittal imbalance correlated more strongly with disability than coronal deformity. Specifically, thoracolumbar and lumbar malalignment were the main cause of disability in this cohort. Figures A through D are lateral standing stereoradiography images of a patient with adult degenerative scoliosis. Figure E is the coronal standing stereoradiograph of this patient. Incorrect Answers: 1. Figure A demonstrates the sacral slope, which is the angle between the S1 endplate and the horizontal. This has not been correlated with ODI. 2. Figure B demonstrates the patient's thoracic kyphosis. Patients with positive sagittal balance may demonstrate decreased thoracic kyphosis as compensation for their deformity. 4. Figure D demonstrates pelvic tilt. Patients with positive sagittal balance may increase their pelvic tilt as compensation for their deformity 5. Figure E demonstrates the patient's pelvic incidence. This parameter has been correlated with risk of spondylolysis.
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