{"paper_id":"2a09e5f8-8706-4ef1-b302-9ff1a4a8dfb9","body_text":"Epidemiological and radiological findings of lumbar degenerative scoliosis in adult patients with low back pain | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiological and radiological findings of lumbar degenerative scoliosis in adult patients with low back pain Hao Li, Hongfei Xiang, Zhu Guo, Xiaolin Wu, Huifei Cui, Zuoran Fan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4065232/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: DLS often accompanied by LBP, however, but few epidemiological study focused on them. The reported results varied considerably and enrolled fewer patients. Thus, it is difficult to know the distributions of DLS. Methods： A retrospective radiographic study enrolled 2193 patients (758 males and 1435 females) with LBP. Among the images, 1000 were taken in a standing position, and 1193 were shot supinely. Measurements included curve type, location, magnitude, coronal Cobb angle, lumbar curvature, and rotatory olisthesis. Results： 212 patients (53 males and 159 females) showed signs of DLS and the overall prevalence was 9.7％, in which women were more affected by DLS with a higher prevalence. Lumbar curvature was greater in the standing group than that in supine group (p=0.015). In DLS cases, Cobb angles averaged 15.3°( 10° to 54.5°), and the degrees of vertebral rotation mostly was grade I or II. There were more left curves than right ones (138:74), more lumbar curves than thoracolumbar ones (181:31). Lateral olisthesis was found in 140 cases and mostly located at L3/4 or L4/5. Coronal Cobb angle appeared positively correlated with apex vertebra rotation and the maximal lateral olisthesis, although negatively correlated with lumbar curvature. Apex vertebra rotation showed a positive linear correlation with maximal lateral olisthesis. Conclusions： The prevalence of DLS in patients with LBP was significantly elevated with age advances, especially in female patient population. Curve type, location, magnitude, coronal Cobb angle, lumbar curvature, and maximal anterioposterior and lateral olisthesis were important elements of radiographic parameters to establish an epidemiological evaluation for DLS. low back pain degenerative lumbar scoliosis radiology epidemiology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Degenerative lumbar scoliosis (DLS) with a Cobb angle of more than 10 degrees in the coronal plain (lateral curvature of the spine) presents a complex three-dimensional rotational deformity after skeletal maturity, is commonly diagnosed on patients over 50 years old and often associated with the loss of sagittal balance and malrotation of the spine[1] . The curves rarely have rotator element above the T10 level, and rarely have a rotator thoracic component. Although the etiology of this condition remains not clear, osteoporosis and degenerative disc disease seem among the most common underline causes[2] . As the geriatric population and life expectancies increase, DLS has become one of the most prevalent deformities in the aging spine[3], and this condition is associated not only with severe back or leg symptoms but also with poor outcomes[4]such as fast progression of symptom and deformity , lower fusion rate, longer operation time, and less improvement post-operationally. [5-7]Scoliosis affects the spine in the coronal, sagittal, and axial planes and thus treatment paradigms devised to address all three components[8]may be a much more difficult challenge. Systematical understanding the distributions of DLS is necessary not only to increase the likelihood of successful treatment outcomes but also to prevent degenerative scoliosis. There have been several studies of the prevalence and radiological changes in adult scoliosis. The incidence of asymptomatic adult scoliosis previously reported varied from 13.3% to 68%, Individuals aged < 60 years had a prevalence of 13% whereas the prevalence estimates were substantially higher in the > 60 age group, Females were more likely to suffer from scoliosis compared with males[9]. Flat back deformity and forward sagittal imbalance have been shown to be a significant source of pain and disability in patients[10, 11]. The limitation of the previous studies includes relatively small sample sizes to correlate the epidemiological distribution and radiographic parameters of DLS with low back pain. In the current study, we intended to carry out a retrospective analysis on a large scale of patient population (more than 2000 cases) to determine the prevalence and epidemiological distribution of DLS in patients with low back pain, identify correlations among relevant radiological parameters, and find whether there is a correlation between radiographic parameters and degenerative scoliosis. In addition, the influence of the patient positions at the x-ray acquisition (standing or supine) was also analyzed and reported, which is also lack in literature. Also we did anticipate an evaluation and characteristics for epidemiology of DLS, and an effective method for diagnosis and prevention 2. Materials and Methods The retrospective study was conducted in the Affiliated Hospital of Qingdao University Medical College. The lumbar radiographs of 2193 outpatients (aged 30 and above) with low back pain were included from picture archiving and communication system (PACS, GE) between April 2018 and Oct.2018. The inclusion criteria for subject enrollment were patients with main complaints of low back pain, radicular pain and/or intermittent claudication. Patients with spinal fractures, lumbar tumor, previous spinal surgical procedures, and history of adolescent scoliosis or radiographic findings consistent with an adolescent idiopathic scoliosis had been excluded[12] . There were 1000 cases x-rayed on standing posture, while other 1193 on supine position. All radiographs were performed by trained technicians using standard techniques with two x-ray machines (one was used for standing image and the other, supine image) (Philips X-Ray machine, Holland; Siemens X-Ray machine, Germany). The whole lumbar spine was taken posteroanteriorly and laterally, all including thoracicolumbar and sacrum. Relevant information (imaging posture, gender and age) of each enrolled patient were recorded. The Cobb method was performed for measurement in each case, where cases with Cobb angle ＞ 10 degrees were diagnosed as DLS. Cobb angles and other radiographic parameters were all measured digitally using PACS. Parameters on the coronal plane included curve type, curve location, curve magnitude, curve direction, coronal Cobb angle, the number of vertebral in the curve, maximal lateral olisthesis and vertebral rotation. Measurements on the sagittal plane included lumbar lordosis and maximal anterioposterior olisthesis(Figure 1 and Figure 2).All the measurements were averaged from two sets of data independently obtained by two spine fellows in order to decrease the intra-observer (Pearson correlation coefficient, r＞0.95) and inter-observer (intraclass correlation coefficient ＞0.94, 95%CI: 0.90～0.96) errors. The subjects were divided into five age groups: 31～40, 41～50, 51～60, 61～70 and ≥71 years. The patients were furthermore sub-grouped to maximal lateral olisthesis (centroid method)[13], vertebral rotation (Nash-Moe grade difference)[14], spondylolisthesis (Meyerding grade difference), and lumbar lordosis（lordosis“+”， kyphosis“-”）[15]. Figure 1. A 57-year-old female patient with DLS was examined at supine posture. The coronal Cobb angle was 12.1°. The left scoliosis presented a curve involving L1-L5 with L3 as the apical vertebra. The maximal Lateral olisthesis showed 9.7mm and was performed by L3/4. The lumbar curvature was +14.4 °, accompanied with a grade I slip of L4. Figure 2. X-ray images of a 68-year-old male patient with DLS acquired with standing posture. The coronal Cobb angle was 27.8 °. The right scoliosis involved T12-L3 with L2 as the apical vertebra. The maximal Lateral olisthesis showed 7.5 mm and was performed by L2/3. The lumbar curvature was +10.3 °, accompanied with a grade I slip of L4. Statistical Analysis Data analyses were performed using SPSS 24.0 (SPSS Inc., Chicago, IL). Pearson Chi-Square test and Mantel-Haenszel test were employed for the prevalence of different aging, gender groups, curve types and curve location. The Mann-Whitney test was used for degrees of vertebral rotation, Independent-sample T-test for the maximal Lateral olisthesis, and the Watson-william test for the coronal curve and sagittal curve measured by Cobb method. Bivariate correlations were tested using either Pearson correlation for normally distributed data or Spearmann’s nonparametric correlation when the data was not normally distributed. P＜0.05 was considered statistically significant. 3. Results 3.1 Prevalence and epidemical distribution of different postures Table 1. Age and gender distribution with different postures Standing Supine Male Female Male Female 31～ 100 112 115 154 41～ 84 134 93 190 51～ 76 165 89 198 61～ 41 111 57 135 71～ 47 130 56 106 total 348 652 410 783 Table 2. Baseline and radiographic parameters with different postures Standing Supine P Mean age 53.3yrs（31～95） 57.1yrs(31～94) P﹦0.108 Gender（male %） 34.8% 34.4% P﹦0.832 Prevalence 8.9%(89/911) 10.3%(123/1070) P﹦0.266 Mean Cobb angle 15.3°（10°～31.3°） 15.2°（10°～54.5°） P﹦0.936 Maximal lateral olisthesis 6.3mm(3～13) 6.8mm(3～18.6) P﹦0.304 Apex vertebra ratation Mostly Grade Ⅰ(50)and GradeⅡ(35) Mostly Grade Ⅰ(68)and GradeⅡ(48) P﹦0.286 Lumbar curvature ＋27.9°（－13.6°～＋60.4°） ＋23.0°（－23.9°～＋64.7°） P﹦0.015 There was no difference of age distribution, gender distribution, prevalence of DLS, mean Cobb angle, and max lateral olisthesis between the two posture groups (Table 1 and Table 2). All patients with DLS showed some degrees of vertebral rotations, mostly Grade I or Grade II. The largest rotation always occurred at apical vertebra, and there was no difference on the apical vertebra rotation between the two position groups. The only parameter that reached the statistical difference between the two position groups was the lumbar curve. Since the posture had no significant effect on all of the data expect the lumbar curve, the following analysis was carried out using pooled data accordingly. 3.2 Age Distribution Figure 3. number of patients in different age groups Table 3. The difference of prevalence among age groups Group prevalence P Group prevalence P 31～ 2.1% p=0.277 31～50 2.6% 41～ 3.2% 51～ 8.1% 51～60 8.1% P＜0.001 61～ 18.9% p=0.186 61～ 20.9% 71～ 23.0% 2193 patients was enrolled in the study and there were 758 males (34.6%) and 1435 females (65.4%), in which 212 (53 male and 159 female) met the definition of DLS. Patients were grouped in age by a decade. The age distribution of DLS in patients with low back pain is illustrated in Fig.3. Mean age was 53.3 years (31 to 96). The prevalence of the DLS was 9.7％. The difference of prevalence between 31~ and 41~ groups was not statistically significant, and neither was between 61~ and 71~ groups. So the data was regrouped to three groups of 31～50, 51~60 and 61～, and there was significant difference among these 3 groups (Table.3). It clearly suggested a significantly elevation of the DLS prevalence with age advances, especially in patients over 60 years old. 3.3 Gender Distribution Table 4. prevalence of DLS in gender groups Males Females P scoliosis non-scoliosis scoliosis non-scoliosis 31～ 4 211 6 260 0.763 41～ 5 172 11 313 0.729 51～ 8 157 35 328 0.062 61～ 17 81 48 198 0.643 71～ 19 84 59 177 0.187 total 758 1435 There were 758 males and 1435 females in the study (1:1.9). Of 758 males with LBP, 53 patients met the definition of DLS and the prevalence was 7.0％, whereas 11.1% (159 cases) in 1435 females. Overall, the prevalence of DLS appeared higher in females than that in males (x2=9.492, P﹤0.01), but it seemed no difference in every age group(Table.4). 3.4 Radiological Parameters and its correlation Of 212 patients with DLS, the mean number of affected vertebrae was 3.6±0.7 (3 to 5) and L1 was the apical vertebra in 5 cases while L2 in 59, L3 in 115 and L4 in 33. Left curve deformity was identified in 138 cases (65.1%), while the other direction deformity resulted in 74 cases (34.9%). There was no difference, however, on the curve directions between age and gender groups (Table.5). Also, 85.4% of the DLS patients (181 cases) had their curve deformity in lumbar segments, the rest (31 cases) were in thoracolumbar segments. No statistical difference on the locations was reached between age and gender groups (Table.5). Cobb angles were resulted in a mean of 15.3°, ranged from 10° to 54.5°. 93.9％ of the patients with DLS (199 cases) had a Cobb angle of 10°to 25°, only 6.1％ (13 cases) showed a Cobb angle of ＞25°. Cobb angles were similar between age and gender groups (Table.5). Maximal Lateral olisthesis (3～18.59mm), having a mean of 6.6±2.8mm, were found in 140 cases and mostly performed at L3/4(58 cases) or L4/5(73 cases), and it suggested no difference between age and gender groups (Table.5). Various degrees of vertebral rotations were found in all cases of DLS. Apical vertebral rotation mostly presented as grade I in 118 cases and grade II in 83, and the apical vertebra was mostly identified as L3 (115 cases).There was no difference on apical vertebral rotation between age and gender groups (Table.5). Spondylolisthesis were found in 95 cases, of which 46 cases forward slipped mostly at L4/5 or L5/S1 and 49 cases slapped backward in ( mostly at L2/3 or L3/4),and one case was diagnosed as grade II while other cases were as grade I. No statistical difference on the locations was found between age and gender groups (Table.5). All correlations among radiographic parameters were statistically analyzed. The results showed that patients with severe scoliosis had a higher incidence of lateral olisthesis and vertebral rotation. Coronal Cobb angle correlated positively with apex vertebra rotation and maximal lateral olisthesis. Apex vertebra rotation showed a positive linear correlation with maximal lateral olisthesis (Fig.4). Coronal Cobb angle showed negative linear correlations with lumbar curvature both in standing and supine DLS cases (Fig.5). Table 5. Radiographic Parameters and number of patients (%) Parameter Range or N(%) P (age groups) P (gender groups) Cobb angle 15.3°(10°～54.5°) p＞0.05 p=0.145 10°～25° 199 (93.9%) ＞25° 13 (6.1%) Affected vertebrae 3.6±0.7 (3～5) Maximal Lateral olisthesis 6.6mm(3～18.59) p=0.888 p=0.907 Apex vertebra L1 5 (2.4%) L2 59 (27.8%) L3 115 (54.2%) L4 33 (15.6%) Curve type Left 138 (65.1%) p=0.305 p=0.868 Right 74 (34.9%) Lumbar 181 (85.4%) p=0.322 p=0.736 Thoracolumbar 31 (14.6%) Apical vertebral rotation p=0.159 p=0.055 Grade Ⅰ 118 (55.7%) Grade Ⅱ 83 (39.2%) Grade Ⅲ 11 (5.1%) Spondylolisthesis 95 (44.9%) p=0.052 p=0.524 Forward slipped 46 (21.7%) Backward slapped 49 (23.1%) Figure 4. Simple scatterplot of Pearson and Spearman correlation among Cobb angle, apex vertebral rotation and maximal lateral olisthesis. (a) Spearman correlation between Cobb angle and apex vertebra retation; (b) Pearson correlation between Cobb angle and maximal lateral olishtesis;(c) Spearman correlation between maximal lateral olisthesis and apex vertebra retation Figure 5. Sample scatterplot of Pearson correlation between Cobb angel and lumbar curvature in standing and supine DLS patients.(a) Pearson correlation between Cobb angle and lumbar curvature in standing patients; (b) Pearson correlation between Cobb angle and lumbar curvature in supine patients. 4. Discussion Degenerative lumbar scoliosis (DLS) is believed to develop as the result of asymmetric degeneration of disc, osteoporosis, and vertebral body compression fractures[16] , and the etiology of DLS remains difficult to be determined. DLS may start with instability at any lumbar intervertebral space. During initial wedging, the remaining vertebrae consequentially wedged toward the opposite apex to maintain balance, and therefore the initial wedging retrogressed[7]. DLS rarely presented as progression of adolescent idiopathic scoliosis, however, it appeared the deformity of the spinal column, by altering the mechanical loading conditions, can accelerate the degenerative cascade.[3] Schwab et al[17]suggested that the initiating cause of DLS was disc degeneration at lumbar level and illustrated the pathological degenerating process of DLS, and this progression may be further accelerated by aging or osteoporosis, particularly in post-menopausal female patients. DLS typically presented with symptoms of LBP, and approximately 90% of patients reported pain as their primary complaint[18]. Pain that localizes over the convexity of the curve is often axial and diffuse in nature which may attribute to muscle fatigue and/or spasm of the paraspinal muscle. However, pain on the concavity of the curve may be the result of the back and nerve roots[8, 19]. In conclusion, LBP was the most frequent complaint in DLS patients. Surgical regime should be offered to patients with pain-related deformity who have failed conservative treatments. Arthrodesis appears beneficial for stabilization, correction, or prevention of curve progression. However, correction of the sagittal balance should be assessed because the loss of lumbar curve has been shown to be associated with poor outcomes[17]. Patients with lumbar curves more than 40°[19], kyphosis greater than 5°and a persistent neurological deficit (radiculopathy or neurogenic claudication) should be considered surgical treatment. Consequently, we expected that radiographic parameters for DLS should be standardized to serve as a basis of analysis and perhaps eventually as treatment guidelines; and surgeons should be aware of the epidemiology, prevalence and related radiological changes [20] The question that arose, therefore, was whether radiographic parameters can be identified in an adult with DLS that will serve a predictive purpose in clinical practice. In this investigation, we illustrated radiographic parameters such as age, Cobb angle, among others. In agreement with widely accepted assumption, this study demonstrated that the deformity become more prevalent with age advance, especially in the populations of 50 years or older. This increase seemed to be the corollary of lumbar spine degenerative changes during adulthood. Few studies assessed the prevalence of DLS in LBP patients. According to a study of 671 patients with low back pain carried out by Perennou and his colleagues[21],7.5％ of patients met the criteria for DLS. In addition, their data showed that the incidence of DLS was 15% among patients of over 60 years, 6％ in 45 to 60 age group and 2％ in patients younger than 40 years of age. With a much large sample size, our study suggested a DLS prevalence of 9.7％ in patients with LBP, which was similar to the Perennou’s report . We also noticed a linear relationship between the prevalence and age. However, the deformity incidence in patients over 60 years old was 20.9％ in our study, dramatically higher than the Perennou’s result. The ratio of men's prevalence to women's in our study was 1 to 1.9, which was similar to Murata’s observation[22] (1 to 2.36) and suggested that women were more affected by DLS. Although the estimated increase in Cobb angle with age advanced was very slow, the significant relationship between the Cobb angle and age was a linear regression, which suggested that the increase was also constant[20]. But in our study, the Cobb angle was similar between age and gender groups. Data suggested the mean of Cobb angle was 15.3°, smaller than that of adolescent idiopathic scoliosis. The Cobb angles of patients in our study covered from 10° to 54.5°, which was not a significant criterion in this group of DLS patients, but it correlated with pain as Schwab and his colleagues considered[17]. Cobb angle may reveal lumbar instability, which may cause pain, but researches[23, 24] revealed a often smaller degrees of coronal Cobb angle in DLS than that of idiopathic scoliosis, and there was no significant relationship between the Cobb angle and the clinical symptoms. As our analyses indicated, coronal Cobb angle had not been affected by imaging postures as well as apical rotation and lateral olisthesis. The curve was rigid and without significant movement, which was different from idiopathic scoliosis, so radiological parameters were similar between standing and supine groups except lumbar curve related to patient’s gravity when standing. Rigid curve and loss of flexibility in DLS patients because osteophytes at the facet joints and at the vertebral endplates, and calcification of the ligamentum flavum and joint capsules. But because of distinct loadings, lumbar curvature of supine patients normally showed obviously lower degrees than that of standing patients. Although clinical symptoms and sagittal curvature could not be veritably identified with supine posture and most patients were recommended to be examined erectly. It had been reported that DLS often accompanied loss of lumbar lordosis[25], which may become the underlying factor in LBP. In our study, lumbar lordosis decreased both in standing and supine groups. Differing from previous reports[21], the patients enrolled in our study performed more left scoliosis (138 cases), which was different from the adolescent idiopathic scoliosis, but showed no statistic difference of curve direction between age and gender groups. Previous studies[1, 2] indicated that most degenerative curves involved a short segment in lumbar region (T11-S1), and the apex frequently located in L3/4 or L2/3 intervertebral space. In our study, DLS involved 3 to 5 vertebrae, and the apical vertebra was mostly identified as L3. The most significant radiographic parameters were rotary subluxation or lateral translation between adjacent lumbar vertebrae on the frontal plane, curve magnitude and its apical vertebra. DLS is a complex three-dimensional change with axial rotational disorder and coronal and sagittal tilting of the vertebra, and lateral olisthesis of the apical vertrbra is related to the progression. When osteoporotic facet joints and vertebral endplates can not compensate the progression of asymmetrical deformity, vertebrae start to rotate and olisthesis in the coronal plane or to shift in the sagittal plane. Common radiographic findings in DLS patients include degenerative changes, most commonly at L5/S1, as well as obliquity at L4/5 and rotary subluxation or lateral translation at L3/4[26], which may indicate severe pain and bad prognosis. Lateral olisthesis appears a late complication of DLS which is more common in those with severe and moderate degrees of scoliosis, and we found maximal Lateral olisthesis with a mean of 6.6mm most located at L3/4or L4/5, without difference between age and gender groups. In Perennou’s[21] study, the correlation was demonstrated between anterior redicular pain and dislocated lumbar scoliosis, especially at the L3/L4 and L4/L5 levels. Degenerative instability and unfavorable lumbar vertebral alignment were related to symptoms rather than lumbar curvature or the cause of the original scoliosis[17] . Shift in the sagittla plane often occurred in spondylolisthesis, an unisegmental form of unstable spinal stenosis, which was found in 95 patients with scoliosis, of which 46 patients forward slipped mostly at L4/5 or L5/S1 and 49 patients slapped backward in (mostly at L2/3 or L3/4). In the 200 adult patients with scoliosis examined by Pritchett and Bortel[27], degenerative spondylolisthesis coexisted in 111. However, the incidence of spondylolisthesis was lower in our study. Murata et al[22] found that DLS was associated with a decrease in segmental lumbar lordosis. Sagittal imbalance occurred gradually with the progression of DLS, which was related to symptoms. Unlike idiopathic scoliosis which usually has no correlation between DLS and relevant radiographic parameters, data from our study revealed that there were positive correlations among apex vertebra rotation, the maximal lateral listhesis and coronal Cobb angle. Because of significant postural effects, when studying the lumbar curvature, we analyzed two posture groups respectively and found a negative correlation between lumbar curvature and the Cobb angle. Therefore, we suggested that three dimensional deformities consisted of vertebral rotation, lateral olisthesis, sagittal imbalance, and mostly the deformities were concurrence and interacting with each other. We believed that our study may be applied to evaluation and characteristics for epidemiology of DLS, and further study focused on DLS in the normal population will help to more accurately understand the epidemiology and find out more closer association between DLS and LBP. Declarations Ethics approval and consent to participate：This research has been performed in accordance with the Declaration of Helsinki and have been approved by Medical Ethics Committee of Qingdao University Affiliated Hospital. Written informed consent was obtained from all subjects and/or their legal guardian(s) Consent for publication：Not applicable. Availability of data and materials：The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Competing interests:The authors declare no potential conflicts of interest. Funding:This study is funded by the Young Taishan Scholars Program (tsqn201909190); National Natural Science Foundation of China (82172478); Shandong Higher Education Young Science and Technology Support Program (2021KJ048);Postdoctoral Science Foundation of China (2022T150340;2021M701813); Qingdao Postdoctoral Applied Research Project (2020); Authors' contributions : B.C., and H. X. contributed in design of experiments, H. C. ,Y.M.and H. L. contributed in literature search, Z. G., H. L., and Z. Z. contributed in conducting the experiments, X. W. and H. L. contributed in data analysis, Z.F., H.C., H.L.and H. X. contributed in manuscript writing, and All authors reviewed the manuscript. Authors' information: Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China Hao Li,Zhu Guo,Zuoran Fan,Huifei Cui,Yuanye Ma,Zhihao Zhang,Bohua Chen & Hongfei Xiang Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China Xiaolin Wu References Aebi, M., The adult scoliosis. Eur Spine J, 2005. 14 (10): p. 925-48. Daffner, S.D. and A.R. Vaccaro, Adult degenerative lumbar scoliosis. Am J Orthop (Belle Mead NJ), 2003. 32 (2): p. 77-82; discussion 82. Diebo, B.G., et al., Adult spinal deformity. Lancet, 2019. 394 (10193): p. 160-172. Sun, X.Y., et al., Correlation between multifidus muscle atrophy, spinopelvic parameters, and severity of deformity in patients with adult degenerative scoliosis: the parallelogram effect of LMA on the diagonal through the apical vertebra. J Orthop Surg Res, 2019. 14 (1): p. 276. 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Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine, 2004. 1 (1): p. 1-8. Jackson, R.P., et al., Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine (Phila Pa 1976), 1998. 23 (16): p. 1750-67. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4065232\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":285784737,\"identity\":\"17e1052b-e424-47e4-b0a8-e8dbd2129553\",\"order_by\":0,\"name\":\"Hao Li\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hao\",\"middleName\":\"\",\"lastName\":\"Li\",\"suffix\":\"\"},{\"id\":285784738,\"identity\":\"425bffee-84ce-4d2b-8429-c063c241974c\",\"order_by\":1,\"name\":\"Hongfei Xiang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYHACA4YPBhLM/AyMDcRrYZxRYcMu2UCKFmaeM2n8BgeIVn/t8DYJ3rbD0sY3ktseMJRZM/C3dyfg13I7rdhAsu2wsdmNxHYDhnPpDBJnzm4goCXH8IFh2+FkszMH2yQY2w4zGEjkEtRicCCx7XD95h4StBg+OHAmjdmAvZFILZJAvxg2VNgwSxxvbDdIOJfOQ9AvfLeTt0n/AUVlM/uzBx/KrOX423vxa1E4gGCzMSSwMfPgVQ4C8g3IWhjYmAnqGAWjYBSMgpEHANwUSf1L3qhzAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Hongfei\",\"middleName\":\"\",\"lastName\":\"Xiang\",\"suffix\":\"\"},{\"id\":285784739,\"identity\":\"51d0cf13-8a0a-4571-beda-22dc81a02a08\",\"order_by\":2,\"name\":\"Zhu Guo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhu\",\"middleName\":\"\",\"lastName\":\"Guo\",\"suffix\":\"\"},{\"id\":285784740,\"identity\":\"529b31c0-4dda-4252-81fa-d5b7018be8de\",\"order_by\":3,\"name\":\"Xiaolin Wu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xiaolin\",\"middleName\":\"\",\"lastName\":\"Wu\",\"suffix\":\"\"},{\"id\":285784741,\"identity\":\"2b661dc0-3933-4a8d-af49-e8a9ebf923f6\",\"order_by\":4,\"name\":\"Huifei Cui\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Huifei\",\"middleName\":\"\",\"lastName\":\"Cui\",\"suffix\":\"\"},{\"id\":285784743,\"identity\":\"f10957c3-9e14-407d-ba53-0881adcb50cf\",\"order_by\":5,\"name\":\"Zuoran Fan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zuoran\",\"middleName\":\"\",\"lastName\":\"Fan\",\"suffix\":\"\"},{\"id\":285784746,\"identity\":\"3dbf8340-0630-45d1-a57f-2881b8421068\",\"order_by\":6,\"name\":\"Yuanye Ma\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yuanye\",\"middleName\":\"\",\"lastName\":\"Ma\",\"suffix\":\"\"},{\"id\":285784748,\"identity\":\"971d83e5-dc3e-409d-a1eb-1087b1ee1a21\",\"order_by\":7,\"name\":\"Zhihao Zhang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhihao\",\"middleName\":\"\",\"lastName\":\"Zhang\",\"suffix\":\"\"},{\"id\":285784750,\"identity\":\"cdf47324-8b28-4c40-ab9e-9b693b10a292\",\"order_by\":8,\"name\":\"Bohua Chen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Affiliated Hospital of Qingdao University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Bohua\",\"middleName\":\"\",\"lastName\":\"Chen\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-03-10 13:17:57\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4065232/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4065232/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":53883637,\"identity\":\"429c55f2-d35a-47d7-946c-bdc5f3df1429\",\"added_by\":\"auto\",\"created_at\":\"2024-04-01 18:27:29\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":181946,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eA 57-year-old female patient with DLS was examined at supine posture. The coronal Cobb angle was 12.1°. The left scoliosis presented a curve involving L1-L5 with L3 as the apical vertebra. The maximal Lateral olisthesis showed 9.7mm and was performed by L3/4. The lumbar curvature was +14.4 °, accompanied with a grade I slip of L4.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"F1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4065232/v1/902387145ba0f8334be58391.png\"},{\"id\":53883634,\"identity\":\"1f526799-fe05-41af-b9f1-2a70369591be\",\"added_by\":\"auto\",\"created_at\":\"2024-04-01 18:27:29\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":241818,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eX-ray images of a 68-year-old male patient with DLS acquired with standing posture. The coronal Cobb angle was 27.8 °. The right scoliosis involved T12-L3 with L2 as the apical vertebra. The maximal Lateral olisthesis showed 7.5 mm and was performed by L2/3. The lumbar curvature was +10.3 °, accompanied with a grade I slip of L4.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"F2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4065232/v1/b51ea0e281004519e69eb7eb.png\"},{\"id\":53883635,\"identity\":\"8841e955-9d4b-4431-9dfa-b665d3a4322f\",\"added_by\":\"auto\",\"created_at\":\"2024-04-01 18:27:29\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":62861,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003enumber of patients in different age groups\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"F3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4065232/v1/37d7942947c3c49595a30bf0.png\"},{\"id\":53883628,\"identity\":\"8db3cbfe-a5bb-46af-8640-95f90b1baa4e\",\"added_by\":\"auto\",\"created_at\":\"2024-04-01 18:27:28\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":17980,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSimple scatterplot of Pearson and Spearman correlation among Cobb angle, apex vertebral rotation and maximal lateral olisthesis. (a) Spearman correlation between Cobb angle and apex vertebra retation; (b) Pearson correlation between Cobb angle and maximal lateral olishtesis;(c) Spearman correlation between maximal lateral olisthesis and apex vertebra retation\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"F4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4065232/v1/b6c8ccd5019fa6c4498f7cca.png\"},{\"id\":53883638,\"identity\":\"72efd321-b2d7-474d-acbc-1ba39676e10b\",\"added_by\":\"auto\",\"created_at\":\"2024-04-01 18:27:29\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":17587,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSample scatterplot of Pearson correlation between Cobb angel and lumbar curvature in standing and supine DLS patients.(a) Pearson correlation between Cobb angle and lumbar curvature in standing patients; (b) Pearson correlation between Cobb angle and lumbar curvature in supine patients\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"F5.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4065232/v1/4f69eddd5366bc45f4d90617.png\"},{\"id\":66849688,\"identity\":\"e63c8ab5-f963-4ef2-b850-fb314960083d\",\"added_by\":\"auto\",\"created_at\":\"2024-10-17 06:39:20\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":995906,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4065232/v1/98ad1dd8-73da-448a-8c8a-f0c8a63bed41.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Epidemiological and radiological findings of lumbar degenerative scoliosis in adult patients with low back pain\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eDegenerative lumbar scoliosis (DLS) with a Cobb angle of more than 10 degrees in the coronal plain (lateral curvature of the spine) presents a complex three-dimensional rotational deformity after skeletal maturity, is commonly diagnosed on patients over 50 years old and often associated with the loss of sagittal balance and malrotation of the spine[1] . The curves rarely have rotator element above the T10 level, and rarely have a rotator thoracic component. Although the etiology of this condition remains not clear, osteoporosis and degenerative disc disease seem among the most common underline causes[2] . As the geriatric population and life expectancies increase, DLS has become one of the most prevalent deformities in the aging spine[3], and this condition is associated not only with severe back or leg symptoms but also with poor outcomes[4]such as fast progression of symptom and deformity , lower fusion rate, longer operation time, and less improvement post-operationally. [5-7]Scoliosis affects the spine in the coronal, sagittal, and axial planes and thus treatment paradigms devised to address all three components[8]may be a much more difficult challenge. Systematical understanding the distributions of DLS is necessary not only to increase the likelihood of successful treatment outcomes but also to prevent degenerative scoliosis.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; There have been several studies of the prevalence and radiological changes in adult scoliosis. The incidence of asymptomatic adult scoliosis previously reported varied from 13.3% to 68%, Individuals aged \\u0026lt;\\u0026thinsp;60 years had a prevalence of 13% whereas the prevalence estimates were substantially higher in the\\u0026thinsp;\\u0026gt; 60 age group, Females were more likely to suffer from scoliosis compared with males[9]. Flat back deformity and forward sagittal imbalance have been shown to be a significant source of pain and disability in patients[10, 11].\\u0026nbsp;The limitation of the previous studies includes relatively small sample sizes to correlate the epidemiological\\u0026nbsp;distribution and radiographic parameters of DLS with low back pain. In the current study, we intended to carry out a retrospective analysis on a large scale of patient population (more than 2000 cases) to determine the prevalence and epidemiological distribution of DLS in patients with low back pain, identify correlations among relevant radiological parameters, and find whether there is a correlation between radiographic parameters and degenerative scoliosis. In addition, the influence of the patient positions at the x-ray acquisition (standing or supine) was also analyzed and reported, which is also lack in literature. Also we did anticipate an evaluation and characteristics for epidemiology of DLS, and an effective method for diagnosis and prevention\\u003c/p\\u003e\"},{\"header\":\"2. Materials and Methods\",\"content\":\"\\u003cp\\u003eThe retrospective study was conducted in the Affiliated Hospital of Qingdao University Medical College. The lumbar radiographs of 2193 outpatients (aged 30 and above) with low back pain were included from picture archiving and communication system (PACS, GE) between April 2018 and Oct.2018. The inclusion criteria for subject enrollment were patients with main complaints of low back pain, radicular pain and/or intermittent claudication. Patients with spinal fractures, lumbar tumor, previous spinal surgical procedures, and history of adolescent scoliosis or radiographic findings consistent with an adolescent idiopathic scoliosis had been excluded[12] .\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThere were 1000 cases x-rayed on standing posture, while other 1193 on supine position. All radiographs were performed by trained technicians using standard techniques with two x-ray machines (one was used for standing image and the other, supine image) (Philips X-Ray machine, Holland; Siemens X-Ray machine, Germany). The whole lumbar spine was taken posteroanteriorly and laterally, all including thoracicolumbar and sacrum.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eRelevant information (imaging posture, gender and age) of each enrolled patient were recorded. The Cobb method was performed for measurement in each case, where cases with Cobb angle\\u0026nbsp;＞\\u0026nbsp;10 degrees were diagnosed as DLS. Cobb angles and other radiographic parameters were all measured digitally using PACS. Parameters on the coronal plane included curve type, curve location, curve magnitude, curve direction, coronal Cobb angle, the number of vertebral in the curve, maximal lateral olisthesis and vertebral rotation. Measurements on the sagittal plane included lumbar lordosis and maximal anterioposterior olisthesis(Figure 1 and Figure 2).All the measurements were averaged from two sets of data independently obtained by two spine fellows in order to decrease the intra-observer (Pearson correlation coefficient, r＞0.95) and inter-observer (intraclass correlation coefficient\\u0026nbsp;＞0.94, 95%CI: 0.90～0.96) errors.\\u003c/p\\u003e\\n\\u003cp\\u003eThe subjects were divided into five age groups: 31～40, 41～50, 51～60, 61～70 and \\u0026ge;71 years. The patients were furthermore sub-grouped to maximal lateral olisthesis (centroid method)[13], vertebral rotation (Nash-Moe grade difference)[14], spondylolisthesis (Meyerding grade difference), and lumbar lordosis（lordosis\\u0026ldquo;+\\u0026rdquo;， kyphosis\\u0026ldquo;-\\u0026rdquo;）[15].\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 1.\\u0026nbsp;\\u003c/strong\\u003e A 57-year-old female patient with DLS was examined at supine posture. The coronal Cobb angle was 12.1\\u0026deg;. The left scoliosis presented a curve involving L1-L5 with L3 as the apical vertebra. The maximal Lateral olisthesis showed 9.7mm and was performed by L3/4. The lumbar curvature was +14.4 \\u0026deg;, accompanied with a grade I slip of L4. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 2.\\u003c/strong\\u003e\\u0026nbsp; X-ray images of a 68-year-old male patient with DLS acquired with standing posture. The coronal Cobb angle was 27.8 \\u0026deg;. The right scoliosis involved T12-L3 with L2 as the apical vertebra. The maximal Lateral olisthesis showed 7.5 mm and was performed by L2/3. The lumbar curvature was +10.3 \\u0026deg;, accompanied with a grade I slip of L4.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical Analysis\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Data analyses were performed using SPSS 24.0 (SPSS Inc., Chicago, IL). Pearson Chi-Square test and Mantel-Haenszel test were employed for the prevalence of different aging, gender groups, curve types and curve location. The Mann-Whitney test was used for degrees of vertebral rotation, Independent-sample T-test for the maximal Lateral olisthesis, and the Watson-william test for the coronal curve and sagittal curve measured by Cobb method. Bivariate correlations were tested using either Pearson correlation for normally distributed data or Spearmann\\u0026rsquo;s nonparametric correlation when the data was not normally distributed. P＜0.05 was considered statistically significant.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e3.1 Prevalence and epidemical distribution of different postures\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1.\\u003c/strong\\u003e Age and gender distribution with different postures\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; Standing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"47.474747474747474%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSupine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e31～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e112\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e115\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e154\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e41～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e134\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e190\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e51～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e165\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e198\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e61～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e111\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e135\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e71～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e130\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e106\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003etotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e348\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.19191919191919%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e652\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.141414141414142%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e410\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e783\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2.\\u003c/strong\\u003e Baseline and radiographic parameters with different postures\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.591836734693878%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; Standing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.632653061224488%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSupine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.244897959183673%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMean age\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.591836734693878%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e53.3yrs（31～95）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.632653061224488%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e57.1yrs(31～94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.244897959183673%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP﹦0.108\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eGender（male %）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.591836734693878%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e34.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.632653061224488%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e34.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.244897959183673%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP﹦0.832\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePrevalence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.591836734693878%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8.9%(89/911)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.632653061224488%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10.3%(123/1070)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.244897959183673%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP﹦0.266\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMean Cobb angle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.591836734693878%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15.3\\u0026deg;（10\\u0026deg;～31.3\\u0026deg;）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.632653061224488%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15.2\\u0026deg;（10\\u0026deg;～54.5\\u0026deg;）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.244897959183673%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP﹦0.936\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMaximal lateral olisthesis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.591836734693878%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6.3mm(3～13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.632653061224488%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6.8mm(3～18.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.244897959183673%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP﹦0.304\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eApex vertebra ratation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.591836734693878%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMostly Grade\\u0026nbsp;Ⅰ(50)and GradeⅡ(35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.632653061224488%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMostly Grade\\u0026nbsp;Ⅰ(68)and GradeⅡ(48)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.244897959183673%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP﹦0.286\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eLumbar curvature\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"29.591836734693878%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e＋27.9\\u0026deg;（－13.6\\u0026deg;～＋60.4\\u0026deg;）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.632653061224488%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e＋23.0\\u0026deg;（－23.9\\u0026deg;～＋64.7\\u0026deg;）\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.244897959183673%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP﹦0.015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eThere was no difference of age distribution, gender distribution, prevalence of DLS, mean Cobb angle, and max lateral olisthesis between the two posture groups (Table\\u0026nbsp;1 and\\u0026nbsp;Table 2). All patients with DLS showed some degrees of vertebral rotations, mostly Grade I or Grade II. The largest rotation always occurred at apical vertebra, and there was no difference on the apical vertebra rotation between the two position groups. The only parameter that reached the statistical difference between the two position groups was the lumbar curve. Since the posture had no significant effect on all of the data expect the lumbar curve, the following analysis was carried out using pooled data accordingly.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.2 Age Distribution\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eFigure 3.\\u0026nbsp;\\u003c/strong\\u003e number of patients in different age groups\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3.\\u003c/strong\\u003e The difference of prevalence among age groups\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eGroup\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003eprevalence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eGroup\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eprevalence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e31～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ep=0.277\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e31～50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e2.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e41～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e51～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e51～60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP＜0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e61～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e18.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ep=0.186\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e61～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003e20.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e71～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e23.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"33.333333333333336%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e2193 patients was enrolled in the study and there were 758 males (34.6%) and 1435 females (65.4%), in which 212 (53 male and 159 female) met the definition of DLS. Patients were grouped in age by a decade. The age distribution of DLS in patients with low back pain is illustrated in Fig.3. Mean age was 53.3 years (31 to 96). The prevalence of the DLS was 9.7％. The difference of prevalence between 31~ and 41~ groups was not statistically significant, and neither was between 61~ and 71~ groups. So the data was regrouped to three groups of 31～50, 51~60 and 61～, and there was significant difference among these 3 groups (Table.3). It clearly suggested a significantly elevation of the DLS prevalence with age advances, especially in patients over 60 years old.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.3 Gender Distribution\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4.\\u003c/strong\\u003e prevalence of DLS in gender groups\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"8.080808080808081%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"32.323232323232325%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; Males\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"32.323232323232325%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFemales\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"27.272727272727273%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"11.428571428571429%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.571428571428573%\\\"\\u003e\\n \\u003cp\\u003escoliosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"25.714285714285715%\\\"\\u003e\\n \\u003cp\\u003enon-scoliosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.571428571428573%\\\"\\u003e\\n \\u003cp\\u003escoliosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"25.714285714285715%\\\"\\u003e\\n \\u003cp\\u003enon-scoliosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"8.24742268041237%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e31～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e211\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e260\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"27.835051546391753%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.763\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"8.24742268041237%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e41～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e172\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e313\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"27.835051546391753%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.729\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"8.24742268041237%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e51～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e157\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e328\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"27.835051546391753%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.062\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"8.24742268041237%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e61～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e198\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"27.835051546391753%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.643\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"8.24742268041237%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e71～\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.402061855670103%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"18.556701030927837%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e177\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"27.835051546391753%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.187\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"8.080808080808081%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003etotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"32.323232323232325%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e758\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"32.323232323232325%\\\" colspan=\\\"2\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1435\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"27.272727272727273%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eThere were 758 males and 1435 females in the study (1:1.9). Of 758 males with LBP, 53 patients met the definition of DLS and the prevalence was 7.0％, whereas 11.1% (159 cases) in 1435 females. Overall, the prevalence of DLS appeared higher in females than that in males (x2=9.492, P﹤0.01), but it seemed no difference in every age group(Table.4). \\u0026nbsp;\\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.4 Radiological Parameters and its correlation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOf 212 patients with DLS, the mean number of affected vertebrae was 3.6\\u0026plusmn;0.7 (3 to 5) and L1 was the apical vertebra in 5 cases while L2 in 59, L3 in 115 and L4 in 33. Left curve deformity was identified in 138 cases (65.1%), while the other direction deformity resulted in 74 cases (34.9%). There was no difference, however, on the curve directions between age and gender groups (Table.5). Also, 85.4% of the DLS patients (181 cases) had their curve deformity in lumbar segments, the rest (31 cases) were in thoracolumbar segments. No statistical difference on the locations was reached between age and gender groups (Table.5).\\u003c/p\\u003e\\n\\u003cp\\u003eCobb angles were resulted in a mean of 15.3\\u0026deg;, ranged from 10\\u0026deg; to 54.5\\u0026deg;. 93.9％\\u0026nbsp;of the patients with DLS (199 cases) had a Cobb angle of 10\\u0026deg;to 25\\u0026deg;, only 6.1％\\u0026nbsp;(13 cases) showed a Cobb angle of\\u0026nbsp;＞25\\u0026deg;. Cobb angles were similar between age and gender groups (Table.5).\\u003c/p\\u003e\\n\\u003cp\\u003eMaximal Lateral olisthesis (3～18.59mm), having a mean of 6.6\\u0026plusmn;2.8mm, were found in 140 cases and mostly performed at L3/4(58 cases) or L4/5(73 cases), and it suggested no difference between age and gender groups (Table.5). Various degrees of vertebral rotations were found in all cases of DLS. Apical vertebral rotation mostly presented as grade I in 118 cases and grade II in 83, and the apical vertebra was mostly identified as L3 (115 cases).There was no difference on apical vertebral rotation between age and gender groups (Table.5). Spondylolisthesis were found in 95 cases, of which 46 cases forward slipped mostly at L4/5 or L5/S1 and 49 cases slapped backward in ( mostly at L2/3 or L3/4),and one case was diagnosed as grade II while other cases were as grade I. No statistical difference on the locations was found between age and gender groups (Table.5).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u0026nbsp;\\u0026nbsp;All correlations among radiographic parameters were statistically analyzed. The results showed that patients with severe scoliosis had a higher incidence of lateral olisthesis and vertebral rotation. Coronal Cobb angle correlated positively with apex vertebra rotation and maximal lateral olisthesis. Apex vertebra rotation showed a positive linear correlation with maximal lateral olisthesis (Fig.4). Coronal Cobb angle showed negative linear correlations with lumbar curvature both in standing and supine DLS cases (Fig.5).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 5.\\u003c/strong\\u003e Radiographic Parameters and number of patients (%)\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\"\\u003e\\n \\u003cp\\u003eParameter\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\"\\u003e\\n \\u003cp\\u003eRange or N(%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003cp\\u003e(age groups)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003cp\\u003e(gender groups)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eCobb angle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15.3\\u0026deg;(10\\u0026deg;～54.5\\u0026deg;)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003ep＞0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003ep=0.145\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 10\\u0026deg;～25\\u0026deg;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e199 (93.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;＞25\\u0026deg;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13 (6.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAffected vertebrae\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3.6\\u0026plusmn;0.7 (3～5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\"\\u003e\\n \\u003cp\\u003eMaximal Lateral olisthesis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\"\\u003e\\n \\u003cp\\u003e6.6mm(3～18.59)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\"\\u003e\\n \\u003cp\\u003ep=0.888\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\"\\u003e\\n \\u003cp\\u003ep=0.907\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eApex vertebra\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp;L1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5 (2.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp;L2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e59 (27.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp;L3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e115 (54.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp;L4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e33 (15.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\"\\u003e\\n \\u003cp\\u003eCurve type\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Left\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\"\\u003e\\n \\u003cp\\u003e138 (65.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ep=0.305\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ep=0.868\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Right\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\"\\u003e\\n \\u003cp\\u003e74 (34.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Lumbar\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\"\\u003e\\n \\u003cp\\u003e181 (85.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ep=0.322\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" rowspan=\\\"2\\\"\\u003e\\n \\u003cp\\u003ep=0.736\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Thoracolumbar\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\"\\u003e\\n \\u003cp\\u003e31 (14.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\"\\u003e\\n \\u003cp\\u003eApical vertebral rotation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003ep=0.159\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" rowspan=\\\"4\\\"\\u003e\\n \\u003cp\\u003ep=0.055\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Grade Ⅰ\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\"\\u003e\\n \\u003cp\\u003e118 (55.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\"\\u003e\\n \\u003cp\\u003eGrade\\u0026nbsp;Ⅱ\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\"\\u003e\\n \\u003cp\\u003e83 (39.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\"\\u003e\\n \\u003cp\\u003eGrade\\u0026nbsp;Ⅲ\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\"\\u003e\\n \\u003cp\\u003e11 (5.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"36.734693877551024%\\\"\\u003e\\n \\u003cp\\u003eSpondylolisthesis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"26.53061224489796%\\\"\\u003e\\n \\u003cp\\u003e95 (44.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.3265306122449%\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003ep=0.052\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"20.408163265306122%\\\" rowspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003ep=0.524\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\"\\u003e\\n \\u003cp\\u003eForward slipped\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\"\\u003e\\n \\u003cp\\u003e46 (21.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"58.064516129032256%\\\"\\u003e\\n \\u003cp\\u003eBackward slapped\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"41.935483870967744%\\\"\\u003e\\n \\u003cp\\u003e49 (23.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 4.\\u0026nbsp;\\u003c/strong\\u003eSimple scatterplot of Pearson and Spearman correlation among Cobb angle, apex vertebral rotation and maximal lateral olisthesis. (a) \\u0026nbsp;Spearman correlation between Cobb angle and apex vertebra retation; (b) Pearson correlation between Cobb angle and maximal lateral olishtesis;(c) Spearman correlation between maximal lateral olisthesis and apex vertebra retation\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 5.\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eSample scatterplot of Pearson correlation between Cobb angel and lumbar curvature in standing and supine DLS patients.(a) Pearson correlation between Cobb angle and lumbar curvature in standing patients; (b) Pearson correlation between Cobb angle and lumbar curvature in supine patients.\\u003c/p\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eDegenerative lumbar scoliosis (DLS) is believed to develop as the result of asymmetric degeneration of disc, osteoporosis, and vertebral body compression fractures[16] , and the etiology of DLS remains difficult to be determined. DLS may start with instability at any lumbar intervertebral space. During initial wedging, the remaining vertebrae consequentially wedged toward the opposite apex to maintain balance, and therefore the initial wedging retrogressed[7]. DLS rarely presented as progression of adolescent idiopathic scoliosis, however, it appeared the deformity of the spinal column, by altering the mechanical loading conditions, can accelerate the degenerative cascade.[3] Schwab et al[17]suggested that the initiating cause of DLS was disc degeneration at lumbar level and illustrated the pathological degenerating process of DLS, and this progression may be further accelerated by aging or osteoporosis, particularly in post-menopausal female patients. DLS typically presented with symptoms of LBP, and approximately 90% of patients reported pain as their primary complaint[18]. Pain that localizes over the convexity of the curve is often axial and diffuse in nature which may attribute to muscle fatigue and/or spasm of the paraspinal muscle. However, pain on the concavity of the curve may be the result of the back and nerve roots[8, 19]. In conclusion, LBP was the most frequent complaint in DLS patients.\\u003c/p\\u003e\\n\\u003cp\\u003eSurgical regime should be offered to patients with pain-related deformity who have failed conservative treatments. Arthrodesis appears beneficial for stabilization, correction, or prevention of curve progression. However, correction of the sagittal balance should be assessed because the loss of lumbar curve has been shown to be associated with poor outcomes[17]. Patients with lumbar curves more than 40\\u0026deg;[19], kyphosis greater than 5\\u0026deg;and a persistent neurological deficit (radiculopathy or neurogenic claudication) should be considered surgical treatment. Consequently, we expected that radiographic parameters for DLS should be standardized to serve as a basis of analysis and perhaps eventually as treatment guidelines; and surgeons should be aware of the epidemiology, prevalence and related radiological changes [20]\\u003c/p\\u003e\\n\\u003cp\\u003eThe question that arose, therefore, was whether radiographic parameters can be identified in an adult with DLS that will serve a predictive purpose in clinical practice. In this investigation, we illustrated radiographic parameters such as age, Cobb angle, among others.\\u003c/p\\u003e\\n\\u003cp\\u003eIn agreement with widely accepted assumption, this study demonstrated that the deformity become more prevalent with age advance, especially in the populations of 50 years or older. This increase seemed to be the corollary of lumbar spine degenerative changes during adulthood.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFew studies assessed the prevalence of DLS in LBP patients. According to a study of 671 patients with low back pain carried out by Perennou and his colleagues[21],7.5％\\u0026nbsp;of patients met the criteria for DLS. In addition, their data showed that the incidence of DLS was 15% among patients of over 60 years, 6％\\u0026nbsp;in 45 to 60 age group and 2％\\u0026nbsp;in patients younger than 40 years of age. With a much large sample size, our study suggested a DLS prevalence of 9.7％\\u0026nbsp;in patients with LBP, which was similar to the Perennou\\u0026rsquo;s report . We also noticed a linear relationship between the prevalence and age. However, the deformity incidence in patients over 60 years old was 20.9％\\u0026nbsp;in our study, dramatically higher than the Perennou\\u0026rsquo;s result. The ratio of men\\u0026apos;s prevalence to women\\u0026apos;s in our study was 1 to 1.9, which was similar to Murata\\u0026rsquo;s observation[22] (1 to 2.36) and suggested that women were more affected by DLS.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough the estimated increase in Cobb angle with age advanced was very slow, the significant relationship between the Cobb angle and age was a linear regression, which suggested that the increase was also constant[20]. But in our study, the Cobb angle was similar between age and gender groups. Data suggested the mean of Cobb angle was 15.3\\u0026deg;, smaller than that of adolescent idiopathic scoliosis. The Cobb angles of patients in our study covered from 10\\u0026deg; to 54.5\\u0026deg;, which was not a significant criterion in this group of DLS patients, but it correlated with pain as Schwab and his colleagues considered[17]. Cobb angle may reveal lumbar instability, which may cause pain, but researches[23, 24] revealed a often smaller degrees of coronal Cobb angle in DLS than that of idiopathic scoliosis, and there was no significant relationship between the Cobb angle and the clinical symptoms.\\u003c/p\\u003e\\n\\u003cp\\u003eAs our analyses indicated, coronal Cobb angle had not been affected by imaging postures as well as apical rotation and lateral olisthesis. The curve was rigid and without significant movement, which was different from idiopathic scoliosis, so radiological parameters were similar between standing and supine groups except lumbar curve related to patient\\u0026rsquo;s gravity when standing. Rigid curve and loss of flexibility in DLS patients because osteophytes at the facet joints and at the vertebral endplates, and calcification of the ligamentum flavum and joint capsules. But because of distinct loadings, lumbar curvature of supine patients normally showed obviously lower degrees than that of standing patients. Although clinical symptoms and sagittal curvature could not be veritably identified with supine posture and most patients were recommended to be examined erectly. It had been reported that DLS often accompanied loss of lumbar lordosis[25], which may become the underlying factor in LBP. In our study, lumbar lordosis decreased both in standing and supine groups.\\u003c/p\\u003e\\n\\u003cp\\u003eDiffering from previous reports[21], the patients enrolled in our study performed more left scoliosis (138 cases), which was different from the adolescent idiopathic scoliosis, but showed no statistic difference of curve direction between age and gender groups. Previous studies[1, 2] indicated that most degenerative curves involved a short segment in lumbar region (T11-S1), and the apex frequently located in L3/4 or L2/3 intervertebral space. In our study, DLS involved 3 to 5 vertebrae, and the apical vertebra was mostly identified as L3.\\u003c/p\\u003e\\n\\u003cp\\u003eThe most significant radiographic parameters were rotary subluxation or lateral translation between adjacent lumbar vertebrae on the frontal plane, curve magnitude and its apical vertebra. DLS is a complex three-dimensional change with axial rotational disorder and coronal and sagittal tilting of the vertebra, and lateral olisthesis of the apical vertrbra is related to the progression. When osteoporotic facet joints and vertebral endplates can not compensate the progression of asymmetrical deformity, vertebrae start to rotate and olisthesis in the coronal plane or to shift in the sagittal plane. Common radiographic findings in DLS patients include degenerative changes, most commonly at L5/S1, as well as obliquity at L4/5 and rotary subluxation or lateral translation at L3/4[26], which may indicate severe pain and bad prognosis. Lateral olisthesis appears a late complication of DLS which is more common in those with severe and moderate degrees of scoliosis, and we found maximal Lateral olisthesis with a mean of 6.6mm most located at L3/4or L4/5, without difference between age and gender groups. In Perennou\\u0026rsquo;s[21] study, the correlation was demonstrated between anterior redicular pain and dislocated lumbar scoliosis, especially at the L3/L4 and L4/L5 levels. Degenerative instability and unfavorable lumbar vertebral alignment were related to symptoms rather than lumbar curvature or the cause of the original scoliosis[17] .\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eShift in the sagittla plane often occurred in spondylolisthesis, an unisegmental form of unstable spinal stenosis, which was found in 95 patients with scoliosis, of which 46 patients forward slipped mostly at L4/5 or L5/S1 and 49 patients slapped backward in (mostly at L2/3 or L3/4). In the 200 adult patients with scoliosis examined by Pritchett and Bortel[27], degenerative spondylolisthesis coexisted in 111. However, the incidence of spondylolisthesis was lower in our study. Murata et al[22] found that DLS was associated with a decrease in segmental lumbar lordosis. Sagittal imbalance occurred gradually with the progression of DLS, which was related to symptoms.\\u003c/p\\u003e\\n\\u003cp\\u003eUnlike idiopathic scoliosis which usually has no correlation between DLS and relevant radiographic parameters, data from our study revealed that there were positive correlations among apex vertebra rotation, the maximal lateral listhesis and coronal Cobb angle. Because of significant postural effects, when studying the lumbar curvature, we analyzed two posture groups respectively and found a negative correlation between lumbar curvature and the Cobb angle. Therefore, we suggested that three dimensional deformities consisted of vertebral rotation, lateral olisthesis, sagittal imbalance, and mostly the deformities were concurrence and interacting with each other.\\u003c/p\\u003e\\n\\u003cp\\u003eWe believed that our study may be applied to evaluation and characteristics for epidemiology of DLS, and further study focused on DLS in the normal population will help to more accurately understand the epidemiology and find out more closer association between DLS and LBP.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eEthics approval and consent to participate：This research has been performed in accordance with the Declaration of Helsinki and have been approved by Medical Ethics Committee of Qingdao University Affiliated Hospital.\\u0026nbsp;Written informed consent was obtained from all subjects and/or their legal guardian(s)\\u003c/p\\u003e\\n\\u003cp\\u003eConsent for publication：Not applicable.\\u003c/p\\u003e\\n\\u003cp\\u003eAvailability of data and materials：The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003eCompeting interests:The authors declare no potential conflicts of interest.\\u003c/p\\u003e\\n\\u003cp\\u003eFunding:This\\u0026nbsp;study\\u0026nbsp;is funded by the Young Taishan Scholars Program (tsqn201909190);\\u0026nbsp;National Natural Science Foundation of China (82172478); Shandong Higher Education Young\\u0026nbsp;Science and Technology Support Program (2021KJ048);Postdoctoral Science Foundation of China (2022T150340;2021M701813); Qingdao Postdoctoral Applied Research Project (2020);\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors\\u0026apos; contributions\\u0026nbsp;:\\u003c/p\\u003e\\n\\u003cp\\u003eB.C., and H. X. contributed in design of experiments, H. C. ,Y.M.and H. L. contributed in literature search, Z. G., H. L., and Z. Z. contributed in conducting the experiments, X. W. and H. L. contributed in data analysis, Z.F., H.C., H.L.and H. X. contributed in manuscript writing, and All authors reviewed the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors\\u0026apos; information:\\u003c/p\\u003e\\n\\u003cp\\u003eDepartment of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China\\u003c/p\\u003e\\n\\u003cp\\u003eHao Li,Zhu Guo,Zuoran Fan,Huifei Cui,Yuanye Ma,Zhihao Zhang,Bohua Chen\\u0026nbsp;\\u0026amp;\\u0026nbsp;Hongfei Xiang\\u003c/p\\u003e\\n\\u003cp\\u003eDepartment of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eXiaolin Wu\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eAebi, M., \\u003cem\\u003eThe adult scoliosis.\\u003c/em\\u003e Eur Spine J, 2005. \\u003cstrong\\u003e14\\u003c/strong\\u003e(10): p. 925-48.\\u003c/li\\u003e\\n\\u003cli\\u003eDaffner, S.D. and A.R. Vaccaro, \\u003cem\\u003eAdult degenerative lumbar scoliosis.\\u003c/em\\u003e Am J Orthop (Belle Mead NJ), 2003. \\u003cstrong\\u003e32\\u003c/strong\\u003e(2): p. 77-82; discussion 82.\\u003c/li\\u003e\\n\\u003cli\\u003eDiebo, B.G., et al., \\u003cem\\u003eAdult spinal deformity.\\u003c/em\\u003e Lancet, 2019. \\u003cstrong\\u003e394\\u003c/strong\\u003e(10193): p. 160-172.\\u003c/li\\u003e\\n\\u003cli\\u003eSun, X.Y., et al., \\u003cem\\u003eCorrelation between multifidus muscle atrophy, spinopelvic parameters, and severity of deformity in patients with adult degenerative scoliosis: the parallelogram effect of LMA on the diagonal through the apical vertebra.\\u003c/em\\u003e J Orthop Surg Res, 2019. \\u003cstrong\\u003e14\\u003c/strong\\u003e(1): p. 276.\\u003c/li\\u003e\\n\\u003cli\\u003eYagi, M., et al., \\u003cem\\u003eCharacterization of Patients with Poor Risk for Clinical Outcomes in Adult Symptomatic Lumbar Deformity Surgery.\\u003c/em\\u003e Spine (Phila Pa 1976), 2021. \\u003cstrong\\u003e46\\u003c/strong\\u003e(12): p. 813-821.\\u003c/li\\u003e\\n\\u003cli\\u003eWu, N., et al., \\u003cem\\u003eFactors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis.\\u003c/em\\u003e BMC Musculoskelet Disord, 2021. \\u003cstrong\\u003e22\\u003c/strong\\u003e(1): p. 483.\\u003c/li\\u003e\\n\\u003cli\\u003eDiebo, B.G., et al., \\u003cem\\u003eAdult spinal deformity.\\u003c/em\\u003e The Lancet, 2019. \\u003cstrong\\u003e394\\u003c/strong\\u003e(10193): p. 160-172.\\u003c/li\\u003e\\n\\u003cli\\u003eWong, E., et al., \\u003cem\\u003eAdult Degenerative Lumbar Scoliosis.\\u003c/em\\u003e Orthopedics, 2017. \\u003cstrong\\u003e40\\u003c/strong\\u003e(6): p. e930-e939.\\u003c/li\\u003e\\n\\u003cli\\u003eMcAviney, J., et al., \\u003cem\\u003eThe prevalence of adult de novo scoliosis: A systematic review and meta-analysis.\\u003c/em\\u003e Eur Spine J, 2020. \\u003cstrong\\u003e29\\u003c/strong\\u003e(12): p. 2960-2969.\\u003c/li\\u003e\\n\\u003cli\\u003eWiggins, G.C., S.L. Ondra, and C.I. Shaffrey, \\u003cem\\u003eManagement of iatrogenic flat-back syndrome.\\u003c/em\\u003e Neurosurg Focus, 2003. \\u003cstrong\\u003e15\\u003c/strong\\u003e(3): p. 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Dennett, \\u003cem\\u003eEffect of stabilization exercise on back pain, disability and quality of life in adults with scoliosis: a systematic review.\\u003c/em\\u003e Eur J Phys Rehabil Med, 2018. \\u003cstrong\\u003e54\\u003c/strong\\u003e(5): p. 647-653.\\u003c/li\\u003e\\n\\u003cli\\u003eBirknes, J.K., et al., \\u003cem\\u003eAdult degenerative scoliosis: a review.\\u003c/em\\u003e Neurosurgery, 2008. \\u003cstrong\\u003e63\\u003c/strong\\u003e(3 Suppl): p. 94-103.\\u003c/li\\u003e\\n\\u003cli\\u003eHong, J.Y., et al., \\u003cem\\u003eThe prevalence and radiological findings in 1347 elderly patients with scoliosis.\\u003c/em\\u003e J Bone Joint Surg Br, 2010. \\u003cstrong\\u003e92\\u003c/strong\\u003e(7): p. 980-3.\\u003c/li\\u003e\\n\\u003cli\\u003eP\\u0026eacute;rennou, D., et al., \\u003cem\\u003eAdult lumbar scoliosis. Epidemiologic aspects in a low-back pain population.\\u003c/em\\u003e Spine (Phila Pa 1976), 1994. \\u003cstrong\\u003e19\\u003c/strong\\u003e(2): p. 123-8.\\u003c/li\\u003e\\n\\u003cli\\u003eMurata, Y., et al., \\u003cem\\u003eChanges in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar scoliosis.\\u003c/em\\u003e Spine (Phila Pa 1976), 2002. \\u003cstrong\\u003e27\\u003c/strong\\u003e(20): p. 2268-73.\\u003c/li\\u003e\\n\\u003cli\\u003eFaraj, S.S.A., et al., \\u003cem\\u003eSagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: a European multicenter analysis.\\u003c/em\\u003e J Neurosurg Spine, 2018. \\u003cstrong\\u003e28\\u003c/strong\\u003e(6): p. 573-580.\\u003c/li\\u003e\\n\\u003cli\\u003eGlassman, S.D., et al., \\u003cem\\u003eThe impact of positive sagittal balance in adult spinal deformity.\\u003c/em\\u003e Spine (Phila Pa 1976), 2005. \\u003cstrong\\u003e30\\u003c/strong\\u003e(18): p. 2024-9.\\u003c/li\\u003e\\n\\u003cli\\u003ePratali, R.R., et al., \\u003cem\\u003eCorrelation between the Severity of the Lumbar Degenerative Disease and Sagittal Spinopelvic Alignment.\\u003c/em\\u003e Rev Bras Ortop (Sao Paulo), 2022. \\u003cstrong\\u003e57\\u003c/strong\\u003e(1): p. 41-46.\\u003c/li\\u003e\\n\\u003cli\\u003eBridwell, K.H., \\u003cem\\u003eSelection of instrumentation and fusion levels for scoliosis: where to start and where to stop. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.\\u003c/em\\u003e J Neurosurg Spine, 2004. \\u003cstrong\\u003e1\\u003c/strong\\u003e(1): p. 1-8.\\u003c/li\\u003e\\n\\u003cli\\u003eJackson, R.P., et al., \\u003cem\\u003eCompensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients.\\u003c/em\\u003e Spine (Phila Pa 1976), 1998. \\u003cstrong\\u003e23\\u003c/strong\\u003e(16): p. 1750-67.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"low back pain, degenerative lumbar scoliosis, radiology, epidemiology\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4065232/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4065232/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e DLS often accompanied by LBP, however, but few epidemiological study focused on them. The reported results varied considerably and enrolled fewer patients. Thus, it is difficult to know the distributions of DLS.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods：\\u003c/strong\\u003eA retrospective radiographic study enrolled 2193 patients (758 males and 1435 females) with LBP. Among the images, 1000 were taken in a standing position, and 1193 were shot supinely. Measurements included curve type, location, magnitude, coronal Cobb angle, lumbar curvature, and rotatory olisthesis.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults：\\u003c/strong\\u003e212 patients (53 males and 159 females) showed signs of DLS and the overall prevalence was 9.7％, in which women were more affected by DLS with a higher prevalence. Lumbar curvature was greater in the standing group than that in supine group (p=0.015). In DLS cases, Cobb angles averaged 15.3°( 10° to 54.5°), and the degrees of vertebral rotation mostly was grade I or II. There were more left curves than right ones (138:74), more lumbar curves than thoracolumbar ones (181:31). Lateral olisthesis was found in 140 cases and mostly located at L3/4 or L4/5. Coronal Cobb angle appeared positively correlated with apex vertebra rotation and the maximal lateral olisthesis, although negatively correlated with lumbar curvature. Apex vertebra rotation showed a positive linear correlation with maximal lateral olisthesis.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions：\\u003c/strong\\u003eThe prevalence of DLS in patients with LBP was significantly elevated with age advances, especially in female patient population. Curve type, location, magnitude, coronal Cobb angle, lumbar curvature, and maximal anterioposterior and lateral olisthesis were important elements of radiographic parameters to establish an epidemiological evaluation for DLS.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Epidemiological and radiological findings of lumbar degenerative scoliosis in adult patients with low back pain\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-04-01 18:27:22\",\"doi\":\"10.21203/rs.3.rs-4065232/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"72ac32af-41ed-44c0-be24-7c2384e6221c\",\"owner\":[],\"postedDate\":\"April 1st, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-10-17T06:39:01+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-04-01 18:27:22\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4065232\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4065232\",\"identity\":\"rs-4065232\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}