General Session: Adult Spinal Deformity

Presented by: J.H. Tan - View Audio/Video Presentation (Members Only)


G. Liu(1), J.H. Tan(1), M.T.M. Win(2), H.K. Wong(1)

(1) National University Hospital, Singapore, University Spine Centre, Department of Orthopaedic Surgery, SINGAPORE, Singapore
(2) National University of Singapore, Yong Loo Lin School of Medicine, National University of Singapore, SINGAPORE, Singapore


Introduction: Scoliosis is known to be biomechanically less stable than a straight spine. The correlation between spinal fractures and the prevalence of scoliosis has not been demonstrated in the literature. The aim of this study was to investigate if scoliosis is a risk factor for development of spinal fractures. Materials and

Method: A retrospective cross-sectional study was conducted using spinal images obtained from DEXA scans of individuals aged ≥40 years to identity spinal fractures. The patients with spinal fractures were divided into two groups; with and without scoliosis. Spinal fracture characteristics and location of spinal fracture (at scoliosis apex, upper end vertebra (UEV) and lower end vertebra (LEV) of scoliosis curve) were described. Risk factors for fractures were analyzed using SPSS software.

Results: 2.9% (202/7045) of the patients were identified to have spinal fractures. The average age of patients with fractures was 76.2 (50-97) years old. 33.2% had scoliosis, and 55% were osteoporotic. 88.6% of fractures were found in Chinese patients. The average Cobb angle was 16.5° (10°-66°). The most common fracture location was at the thoracolumbar junction (74.3%, 150/202). 40% (80/202) occurred at T12, while 35% (70/202) of the fractures occurred at L1. Fractures were found in 17% (110/645) of scoliotic patients. 30% (20/67) of the fractures occurred around UEV, 19.4% (13/67) at apex, and only 4.5% (3/67) around LEV. Subgroup analysis showed that 66% (44/67) of fractures occurred at T12 and L1 in scoliotic patients, while 72% (97/135) of fractures occurred at T12 and L1 in non-scoliotic patients. In multivariate analysis, scoliosis (p=0.01), increasing Cobb angle (21-30o: RR=4.945, 95%CI: 1.602-15.268, >30o: RR=6.14, 95%CI: 1.063-35.505), Chinese race (RR=2.64, 95%CI: 1.065-6.546), osteoporosis (RR= 1.68, 95%CI: 1.33-2.12) and increasing age (RR=1.118, 95% CI: 1.086-1.152) were identified as statistical significant risk factors for spinal fracture development.

Conclusion: This is the first report to demonstrate degenerative scoliosis as a risk factor for thoracolumbar spinal fractures development. The average fracture rate in Singaporean adults over 40 years is 2.9%. Patients with Cobb angle over 30o, Chinese race, osteoporotic and increasing age have 6X, 2.6X, 1.7X and 1.1X higher risk for thoracolumbar spinal fractures development respectively.