Who Gets Degenerative Scoliosis

[LindaRacine]

Hi...

While looking for something else today, I came across a paper that I thought might be of interest to some. It's from Spine journal, and was published in 2006. It's titled "A Prospective Study of De Novo Scoliosis in a Community Based Cohort."

It turns out this Japanese group recruited about 500 volunteers, aged 50-84, from 1983 to 1987. They took standing radiographs of the entire cohort. For this particular paper, they chose 60 subjects (18 men and 42 women) without any scoliosis at baseline. They followed these subjects for 12 years. During that period of observation, they found that 22 of the 60 subjects went on to develop de novo scoliosis. So, that at least answers the question as to whether all degenerative scoliosis cases might have had idiopathic scoliosis when they were younger.

I talked to Dr. Hu about degenerative scoliosis today, because i read something in another paper that didn't make sense. In that paper, the author split degenerative scoliosis into degenerative scoliosis with rotation and degenerative scoliosis without rotation. He essentially claimed that scoliosis without rotation was degenerative scoliosis and scoliosis with rotation was idiopathic scoliosis. Dr. Hu says that everyone with degenerative scoliosis will eventually have rotation, just as everyone with idiopathic scoliosis with eventually have totation. So, if it's caught early enough, an adult with (non-congenital or neuromuscular) scoliosis and no rotation can be presumed to have degenerative scoliosis. Although, like just about everything have to deal with scoliosis, it's a rather imperfect science.


--Linda

[hdugger]

I can't make sense of this.

If this is a representative population, that would suggest that 1/3 of adults will develop scoliosis. But . . . I haven't seen numbers anything like that. I *have* seen plenty of adults developing kyphosis, but not scoliosis.

Do they say what made them choose this subset to study? Or . . . is there some raging adult scoliosis epidemic in Japan?

[LindaRacine]

I can't make sense of this.

If this is a representative population, that would suggest that 1/3 of adults will develop scoliosis. But . . . I haven't seen numbers anything like that. I *have* seen plenty of adults developing kyphosis, but not scoliosis.

Do they say what made them choose this subset to study? Or . . . is there some raging adult scoliosis epidemic in Japan?

The incidence of adult scoliosis (most due to degeneration) has been reported as high as 68%:

Spine (Phila Pa 1976). 2005 May 1;30(9):1082-5.
Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population.

Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP.

Department of Orthopaedic Surgery, Spine Service, Maimonides Medical Center, Brooklyn, NY, USA. fschwab@worldnet.att.net
Abstract

STUDY DESIGN: A prospective self-assessment analysis and evaluation of nutritional and radiographic parameters in a consecutive series of healthy adult volunteers older than 60 years.

OBJECTIVES: To ascertain the prevalence of adult scoliosis, assess radiographic parameters, and determine if there is a correlation with functional self-assessment in an aged volunteer population.

SUMMARY OF BACKGROUND DATA: There exists little data studying the prevalence of scoliosis in a volunteer aged population, and correlation between deformity and self-assessment parameters.

METHODS: There were 75 subjects in the study. Inclusion criteria were: age > or =60 years, no known history of scoliosis, and no prior spine surgery. Each subject answered a RAND 36-Item Health Survey questionnaire, a full-length anteroposterior standing radiographic assessment of the spine was obtained, and nutritional parameters were analyzed from blood samples. For each subject, radiographic, laboratory, and clinical data were evaluated. The study population was divided into 3 groups based on frontal plane Cobb angulation of the spine. Comparison of the RAND 36-Item Health Surveys data among groups of the volunteer population and with United States population benchmark data (age 65-74 years) was undertaken using an unpaired t test. Any correlation between radiographic, laboratory, and self-assessment data were also investigated.

RESULTS: The mean age of the patients in this study was 70.5 years (range 60-90). Mean Cobb angle was 17 degrees in the frontal plane. In the study group, 68% of subjects met the definition of scoliosis (Cobb angle >10 degrees). No significant correlation was noted among radiographic parameters and visual analog scale scores, albumin, lymphocytes, or transferrin levels in the study group as a whole. Prevalence of scoliosis was not significantly different between males and females (P > 0.03). The scoliosis prevalence rate of 68% found in this study reveals a rate significantly higher than reported in other studies. These findings most likely reflect the targeted selection of an elderly group. Although many patients with adult scoliosis have pain and dysfunction, there appears to be a large group (such as the volunteers in this study) that has no marked physical or social impairment.

CONCLUSIONS: Previous reports note a prevalence of adult scoliosis up to 32%. In this study, results indicate a scoliosis rate of 68% in a healthy adult population, with an average age of 70.5 years. This study found no significant correlations between adult scoliosis and visual analog scale scores or nutritional status in healthy, elderly volunteers.

[hdugger]

Wow. Well, they sure are hiding it well!

I'm assuming, since the average Cobb was so low, that the majority of these people don't fall into the "surgical range" of 50+ degrees.

So, these are just people whose disks wear out unevenly side-to-side?