Vertebral Rotatory Subluxation in Degenerative Scoliosis

Study Design. A cross-sectional study. Objective. To identify facet tropism as one of the possible risk factors leading to vertebral rotatory subluxation (VRS). Summary of Background Data. VRS has been considered as one of the prognostic factors for degenerative scoliosis. Although several risk factors of VRS, including age and Cobb angle, have been investigated, few studies exist that have evaluated the correlation between VRS and anatomical structures of the vertebral column. Methods. This retrospective study recruited 23 patients diagnosed with degenerative lumbar scoliosis with VRS and 20 patients with degenerative scoliosis without VRS. The lateral translation on coronal radiographs was measured and 5 mm was used as the cutoff value to define rotatory subluxation. Computed tomographic scans for facet joints were made for all lumbar levels. The difference between right and left facet angles was recorded as Delta FA. Facet tropism was defined as a difference between the bilateral facet angles of more than 10 degrees. Results. In this study, VRS was most commonly found at the L3-L4 level (49%) and, with decreasing frequency at L2-L3 (24%), L4-L5 (20%), and L1-L2 (7%). On the convex side of the main curve, face joints at levels with VRS were more coronally oriented compared with those at levels without VRS (41.64 degrees +/- 11.65 degrees vs. 36.30 degrees +/- 10.99 degrees, P = 0.034). Delta FA was also significantly different between levels with and without VRS ( P = 0.005). A strong correlation was found between Delta FA and lateral translation, with a coefficient of 0.33 (P < 0.001). In addition,. FA and a larger Cobb angle were found to be significantly associated with VRS based on binary regression analysis, with an odds ratio of 4.68 and 2.14, respectively. Conclusion. Facet tropism was more significantly observed at levels with VRS. On the convex side of the main curve, facet joints at levels with VRS were more coronally oriented. A larger Cobb angle and severe facet tropism in degenerative scoliosis should be considered to be related to VRS.