Although adult symptomatic lumbar scoliosis (ASLS) has a significant health impact, these patients frequently have concomitant orthopedic problems that have not been assessed. Based on a retrospective examination of a prospective multicenter cohort, this study determined the disease burden of another orthopedic disorder in patients with ASLS. The ASLS-1 study is a prospective multicenter study funded by the National Institutes of Health that compares surgical and nonoperative treatment for ASLS. Patients with ASLS were 40–80 years old. They had a lumbar coronal Cobb angle of less than 30°, an Oswestry Disability Index of less than 20, or a Scoliosis Research Society-22 questionnaire score of less than 4.0 in the pain, function, and self-image domains. From enrollment to the 4-year follow-up, nonthoracolumbar orthopedic events, defined as fractures and other orthopedic problems requiring surgical treatment, were examined.

A total of 286 patients (mean age 60.3 years, 90% women) were enrolled, with 173 undergoing surgery and 113 not, and 81% having 4-year follow-up data. One hundred four nonthoracolumbar orthopedic occurrences were observed after a mean (± SD) follow-up of 3.8 ± 0.9 years, affecting 69 patients (24.1%). Arthroplasty (n = 38), fracture (n = 25), joint ligament/cartilage repair (n = 13), and cervical decompression/fusion (n = 7) were the most common occurrences. Patients with a nonthoracolumbar orthopedic incident were older (HR 1.44 per decade, 95% CI 1.07–1.94), more likely to have smoked in the past (HR 1.63, 95% CI 1.00–2.66), and had poorer baseline leg pain scores (HR 1.10, 95% CI 1.01–1.19), according to the final adjusted model.

Patients with ASLS have a significant burden of orthopedic disease, with nearly 25% having a fracture or nonthoracolumbar orthopedic problem needing surgery during the first 3.8 years of enrolment. According to earlier studies, compared to the same-aged general US population, the ASLS-1 cohort had a much higher rate of total knee arthroplasty and at least as high as total hip arthroplasty. In patients with ASLS, these problems may have an even greater impact on health-related quality of life and outcomes assessments of nonoperative and surgical treatment modalities.