**Abstract**

Degenerative lumbar scoliosis (DLS) is commonly seen in people over the age of 50 years. The prevalence increases with age. Patients with DLS often complain of low back pain and radiculopathy. Neurological complaints are rare. Current treatments are generally targeted at pain relief. Effects are temporary; this is understandable as the spinal deformities which are the cause of the pain are not addressed. A few studies have shown that scoliosis specific exercises and lordotic bracing stabilize or reduce the rate of curve progression in patients with DLS. Patients should also be instructed in performing corrective movements in daily activities. In the presence of sarcopenia or decreased bone mineral density (BMD), resistance exercises and nutritional supplements should also be prescribed, as reduction in paraspinal muscle mass and BMD are risk factors of DLS. In the presence of neurological involvement or when the symptoms are refractory to conservative treatment, referral for surgery is required.

**Keywords:** degenerative lumbar scoliosis, adult scoliosis, scoliosis-specific exercise, spinal brace, sarcopenia, osteoporosis

## **1. Introduction**

Adult scoliosis includes adult idiopathic scoliosis as well as degenerative lumbar scoliosis (DLS). DLS is a de novo scoliosis. It is defined as a lateral curvature of the spine in excess of 10° and a sagittal vertical axis (SVA) of more than 50 mm. in an adult over 50 years of age [1]. The sagittal vertical axis is the horizontal distance from the vertical plumbline dropped from the centroid of C7 to the posterosuperior corner of the sacral end plate.

The prevalence of DLS varies with different studies. The reported rate ranges from 8.3–68% [2–5]. The marked variation in prevalence reported is possibly a result of the differences in inclusion criteria of the different studies. Kilshaw et al. [6] evaluated the prevalence of lumbar scoliosis using abdominal and kidney–ureterbladder radiographs on patients over the age of 20 years [6]. The study showed that lumbar scoliosis is more prevalent in women and increases with age [6]. At the ages of between 60 and 69 years, the prevalence was 6%, whereas at the age of 90 years, the prevalence was over 30% [6]. It has, however, to be noted that the study did not differentiate between adult idiopathic scoliosis and DLS and that the radiographs employed were supine films, which might underestimate the Cobb angle and thus the prevalence of lumbar scoliosis. Xu et al. [7] evaluated 2395 Han Chinese over 40 years of age for the presence of DLS, using dual energy X-ray absorptiometry (DEXA) images. They reported a prevalence of 13.3%, with females more commonly affected than males. Also, the prevalence increased with age [7]. Prevalence was reduced with increasing curve severity; over 80% of the patients with DLS had curves in between 10° and 20° [7].
