General Session: Adult Spinal Deformity-2

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

Author(s):

G. Liu(1), J.H. Tan(1), G. Ee(1), Y.H. Chan(2), S.L. Low(3), H.K. Wong(1)

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

Abstract

Introduction: Degenerative Lumbar scoliosis affects the quality of patient´s life and burdens the health care system as population ages, yet few reported its prevalence in Asians. This study aims to identify scoliosis prevalence, curve characteristic and its risk factors for development. Methodology: Spinal images obtained from DEXA scans of individual age ≥40 years were reviewed retrospectively at a university hospital. A multivariate analysis for risk factors for development of lumbar scoliosis was performed.

Results: 645 (9.1%, 95% CI 8.5%-9.8%) of 7075 patients were identified to have scoliosis with Cobb's angle ≥ 10°. The average age of scoliotic patient was 61 years old (40-98); Average BMI was 23.3; Average BMD was 0.87. A near exponential increase in prevalence of scoliosis was found in patients from 4th decade of life (3.9%) to >8th decade of life (25.1%).The average scoliotic Cobb angle was 16.5° (10°-66°). Curve apex was most commonly found at L2 (53%) and L3 (20%). 47% of patients with scoliosis had Nash & Moe grade 1 apical vertebral rotation and 21% had grade 2 rotation. In multivariate analysis, female patients (RR=2.4), Chinese patients (RR=2.4), Malay patients (RR=2.5) and patient with spinal fracture (RR=5.1) had increased risk of scoliosis diagnosis. Increased risk was found as patients progressed through each decade from age 40 years old.

Conclusion: In conclusion, the prevalence of lumbar scoliosis in our population is 9.1%. Increased age, female, Chinese and Malay patients and patients with vertebral fracture have increased risk of scoliosis development. To the best of the authors' knowledge, this study provides the largest epidemiological and risk factors data for the healthcare planning in aging Asian patients with degenerative lumbar scoliosis.