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Bertelè L, Giorgi V, Bellavite P, Apostolo G, Ortolani R, Fila A, Zanolin E. Relationship between inflammatory laboratory parameters and severity of adolescent idiopathic scoliosis: A pilot study. J Back Musculoskelet Rehabil 2024; 37:943-954. [PMID: 38306021 DOI: 10.3233/bmr-230186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Adolescent idiopathic scoliosis is a complex condition whose pathogenesis may include inflammation and signs of joint and bone degeneration. OBJECTIVE The main objective of this study is to evaluate the relationship between the severity of adolescent idiopathic scoliosis and inflammatory blood parameters. METHODS The study recruited patients with adolescent idiopathic scoliosis who attended the Rehabilitation Center of the Apostolo Foundation in Merate (LC). The scoliosis curve (Cobb's angle) was used as a severity index to compare with inflammatory blood parameters (white blood cells subpopulations, immunoglobulins, protein electrophoresis). In addition, the study used an overall severity grading called "Scoliosis Score" which includes all spine angles and Risser's score (bone development index). RESULTS Thirty-four subjects were recruited (mean age 14 years, 2 months), 30 females and 2 males. A significant correlation was found between Cobb's angle and the percentage values of beta-2 globulins in a directly proportional manner (r= 0.42, p= 0.01), and gamma globulins in an inversely proportional manner (r=-0.366, p= 0.04). However, no significant correlation between Cobb's angle and the absolute values of white blood cells and percentage subpopulations was found (r= 0.0821 p= 0.655). A moderate, inverse correlation was found between the Scoliosis Score and the percentage of neutrophils (r=-0.385, p= 0.02), a direct correlation was found between the Scoliosis Score and the percentage of lymphocytes (r= 0.404, p= 0.02). In addition, there was a strong correlation of the Scoliosis Score with alpha-2 globulin (r= 0.564, p= 0.0012), beta-1 globulin (r= 0.478, p= 0.0074), and beta-2 globulin (r= 0.370, p= 0.044) and an inverse relationship with gamma globulin (r=-0.625, p= 0.0002). The main correlations were confirmed by regression analysis. CONCLUSION The correlation between beta-2 globulins and gamma globulins with Cobb's angle and the Scoliosis Score suggests a link between spinal curvature and inflammation in scoliosis patients, This link may indicate the significance of these parameters for diagnosing, staging the disease, and monitoring therapies.
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Affiliation(s)
- Laura Bertelè
- Rehabilitation Center "Apostolo Foundation", Merate, Italy
| | - Valeria Giorgi
- Rehabilitation Center "Apostolo Foundation", Merate, Italy
| | | | | | - Riccardo Ortolani
- Ospedale Policlinico, Dipartimento di Medicina, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alice Fila
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisabetta Zanolin
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Chu ECP, Cheng HY, Huang K, Yao K, Zhao J. Conservative Management of Low Back Pain and Scoliosis in a Patient With Rheumatoid Arthritis: Eight Years Follow-Up. Cureus 2023; 15:e36036. [PMID: 36919112 PMCID: PMC10008232 DOI: 10.7759/cureus.36036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/14/2023] Open
Abstract
Scoliosis in patients with rheumatoid arthritis (RA) can cause significant pain and disability. RA has been extensively studied in relation to the cervical spine, yet the pathology of the thoracic and lumbar spine in RA patients has been largely overlooked. A 66-year-old woman, with longstanding RA and severe scoliosis, presented to the chiropractic clinic with a five-month history of exacerbated low back pain radiating to the right lower limb. The patient was treated with a combination of full-spine mechanical spinal distraction, spinal manipulative therapy, mechanical distraction of the cervical spine, and soft tissue treatment (scraping therapy). Thereafter, the patient recovered from the pain and radiculopathy and showed improvements in the radiological parameters, walking gait, and postural balance. Radiography was performed at the 12-month, four-year, and eight-year follow-up appointments and revealed improvements in symptoms, posture, and scoliosis. Although the treatment for RA-related scoliosis is similar to that for other types of scoliosis, due to the nature of RA, treatment should be tailored to individual patients. This case report highlights the importance of considering chiropractic therapy for the management of lumbar scoliosis in patients with RA, as a comprehensive treatment plan resulted in improved spinal balance, mobility, gait, posture, and quality of life.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Medical Group (NYMG) Chiropractic Department, EC Healthcare, Hong Kong, HKG
| | - Hay Yeung Cheng
- New York Medical Group (NYMG) Chiropractic Department, EC Healthcare, Hong Kong, HKG
| | - Kevin Huang
- New York Medical Group (NYMG) Chiropractic Department, EC Healthcare, Yuen Long, HKG
| | - Kristy Yao
- New York Medical Group (NYMG) Chiropractic Department, EC Healthcare, Taikoo, HKG
| | - Jason Zhao
- New York Medical Group (NYMG) Chiropractic Department, EC Healthcare, Hong Kong, HKG
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Yamada K, Suzuki A, Takahashi S, Inui K, Koike T, Okano T, Yabu A, Hori Y, Toyoda H, Nakamura H. Incidence of and risk factors for spondylolisthesis, scoliosis, and vertebral fracture in rheumatoid arthritis. J Bone Miner Metab 2022; 40:120-131. [PMID: 34424413 DOI: 10.1007/s00774-021-01261-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/04/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Although lumbar lesions such as spondylolisthesis, scoliosis, and vertebral fracture are not specific to rheumatoid arthritis (RA), the prevalence is high in RA patients. However, no longitudinal study has evaluated lumbar lesions in RA. This study aimed to investigate the incidence of and risk factors for lumbar lesions in RA by a prospective longitudinal cohort study. MATERIALS AND METHODS The study cohort comprised 110 patients with RA from the 'analysis of factors for RA spinal disorders (AFFORD)' study who completed the secondary survey at a single orthopaedic outpatient RA clinic. Radiological examination included standing radiographs and magnetic resonance imaging (MRI) of the lumbar spine. New development of spondylolisthesis, scoliosis, and vertebral fracture were assessed between baseline and secondary survey. RESULTS The incidences of spondylolisthesis, scoliosis, and vertebral fracture were 42%, 16%, and 12%, respectively, during a mean follow-up of 7 years. The independent risk factor for de novo scoliosis was poor control of RA (adjusted odds ratio [aOR] 4.81, p = 0.011), while the independent risk factors for new vertebral fracture was use of glucocorticoid at secondary survey (aOR 14.87, p = 0.012). Patients with de novo scoliosis exhibited more severe low back pain and lower quality of life than those without. CONCLUSION The incidence of scoliosis was related in patients with poor control of RA, while new vertebral fracture was more common in patients with use of glucocorticoid. Control of disease activity might be important in preventing radiological lumbar disorders in RA.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedic Surgery, PL Hospital, 2204, Shindo, Tondabayashi City, Osaka, 584-8585, Japan.
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan.
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Kentaro Inui
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Tatsuya Koike
- Center for Senile Degenerative Disorders (CSDD), Osaka City University, Osaka City, Osaka, Japan
| | - Tadashi Okano
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University, Osaka City, Osaka, Japan
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Koban O, Öğrenci A, Akar EA, Uyanık AS, Yılmaz M, Dalbayrak S. Radiological and clinical comparisons of the patients with rheumatoid arthritis operated with rigid and dynamic instrumentation systems due to lumbar degenerative spinal diseases. J Orthop Sci 2021; 26:369-374. [PMID: 32600905 DOI: 10.1016/j.jos.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/14/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is extremely difficult to treat spine disorders with stabilization in patients with rheumatoid arthritis. Because revision rates are significantly higher in rigid stabilization. To date, there is no data about patients with rheumatoid arthritis treated with dynamic stabilization. Our aim was to compare the radiological and clinical results of patients with rheumatoid arthritis who underwent lumbar rigid stabilization or dynamic stabilization with Polyetheretherketone rod (PEEK). METHODS Patients with degenerative lumbar spine disease with rheumatoid arthritis who underwent dynamic stabilization between 2013 and 2015 and rigid stabilization between 2010 and 2012 were evaluated radiologically for adjacent segment disease, proximal junctional kyphosis, system problem (nonunion, screw loosening, instrumentation failure, pull out). It was also compared according to both the revision rates and the Visual Analog Scale and Oswestry Disability Index scores at the 12th month and 24th month. RESULTS The difference of decrease in Visual Analog Scale and Oswestry Disability Index scores from preoperative to 12th month between patients who underwent dynamic stabilization and rigid stabilization was statistically insignificant. However, there was a significant difference of increase in Visual Analog Scale and Oswestry Disability Index scores between the 12th month and 24th month of patients who underwent rigid stabilization, compared with patients with dynamic stabilization. In patients with dynamic stabilization, the problems of instrumentation were seen less frequently. Revision rates were high in patients with rigid stabilization when compared the patients with dynamic stabilization. CONCLUSION Radiological and clinical outcomes in patients with rheumatoid arthritis operated with dynamic stabilization are more significant when compared to rigid stabilization. These patients have lower pain and disability scores in their follow up periods. Revision rates are lower in patients with dynamic stabilization.
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Affiliation(s)
- Orkun Koban
- Okan University, Department of Neurosurgery, Istanbul, Turkey.
| | - Ahmet Öğrenci
- Okan University, Department of Neurosurgery, Istanbul, Turkey
| | - Ezgi Ayçiçek Akar
- Haydarpaşa Numune Research and Training Hospital, Department of Neurosurgery, Istanbul, Turkey
| | | | - Mesut Yılmaz
- Neurospinal Academy, Department of Neurosurgery, Istanbul, Turkey
| | - Sedat Dalbayrak
- Okan University, Department of Neurosurgery, Istanbul, Turkey
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Schell TL, Krueger D, Binkley N, Hetzel S, Bernatz JT, Anderson PA. Opportunistic use of dual-energy X-ray absorptiometry to evaluate lumbar scoliosis. Arch Osteoporos 2021; 16:38. [PMID: 33624177 DOI: 10.1007/s11657-021-00898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/21/2021] [Indexed: 02/03/2023]
Abstract
Low bone mineral density is associated with spinal deformity. Dual-energy X-ray absorptiometry (DXA), a modality that assesses bone density, portends a theoretical means to also assess spinal deformity. We found that DXA can reliably assess spine alignment. DXA may permit surveillance of spine alignment, i.e., scoliosis in the clinical setting. PURPOSE Osteoporosis and scoliosis are interrelated disease processes. Dual-energy X-ray absorptiometry (DXA), used to assess bone density, can also be used to evaluate spinal deformity since it captures a posteroanterior (PA) image of the lumbar spine. We assessed the use of DXA to evaluate lumbar spine alignment. METHODS A lumbar spine DXA phantom was used to assess the effects of axial and sagittal plane rotation on lumbar bone mineral content (BMC), density (BMD), and L1-L4 Cobb angle measurements. Using two subject cohorts, intra- and inter-observer reliability and validity of using DXA for L1-L4 Cobb angle measurements in the coronal and sagittal planes were assessed. RESULTS Axial and sagittal plane rotation greater than 15° and 10°, respectively, significantly reduced measured BMD and BMC; there was minimal effect on Cobb angle measurement reliability. In human subjects, excellent intra- and inter-observer reliability was observed using lumbar PA DXA images for Cobb angle measurements. Agreement between Cobb angles derived from lumbar PA DXA images and AP lumbar radiographs ranged from good to excellent. The mean difference in Cobb angles between supine lumbar PA DXA images and upright AP lumbar radiographs was 2.8° in all subjects and 5.8° in those with scoliosis. CONCLUSIONS Lumbar spine rotation does not significantly affect BMD and BMC within 15° and 10° of axial and sagittal plane rotation, respectively, and minimally affects Cobb angle measurement. Spine alignment in the coronal plane can be reliably assessed using lumbar PA DXA images.
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Affiliation(s)
- Trevor L Schell
- Department of Orthopedics and Rehabilitation, Medical Foundation Centennial Building, University of Wisconsin, 1685 Highland Ave, 6th floor, Madison, WI, 53705-2281, USA
| | - Diane Krueger
- Osteoporosis Clinical Research Program, University of Wisconsin, 2870 University Avenue, Madison, WI, 53705, USA
| | - Neil Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin, 2870 University Avenue, Madison, WI, 53705, USA
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 207G WARF Office Building, 610 Walnut Street, Madison, WI, 53726, USA
| | - James T Bernatz
- Department of Orthopedics and Rehabilitation, Medical Foundation Centennial Building, University of Wisconsin, 1685 Highland Ave, 6th floor, Madison, WI, 53705-2281, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, Medical Foundation Centennial Building, University of Wisconsin, 1685 Highland Ave, 6th floor, Madison, WI, 53705-2281, USA.
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Abstract
STUDY DESIGN Narrative review. OBJECTIVE To provide an overview on the diagnosis and surgical management of rheumatoid involvement of the lumbar spine. Rheumatoid arthritis (RA) is a chronic inflammatory disease of synovial joints, most commonly appendicular followed by axial. Although cervical spine involvement of RA is well documented, data on lumbar spine involvement and surgical management remains limited. METHODS Using PubMed, studies published prior to November 2018 with the keywords "RA, etiology"; "RA, spine management"; "RA, surgical management"; "RA, treatment"; "RA, DMARDs"; "RA, lumbar spine"; "RA, spine surgical outcomes"; "RA, imaging" were evaluated. RESULTS The narrative review addresses the epidemiology, manifestations, imaging, surgical complications, and operative and nonoperative management of RA involvement of the lumbar spine. CONCLUSIONS Rheumatoid involvement of the lumbar spine can present with lower back pain, neurogenic claudication, radiculopathy, spinal deformity, and instability. Patients with RA have significantly higher rates of vertebral fractures and complications following surgical intervention. However, in the setting of instability and spinal deformity, thoughtful surgical planning in conjunction with optimal medical management is recommended.
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Affiliation(s)
- Peter Joo
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Laurence Ge
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Addisu Mesfin
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA,Addisu Mesfin, Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.
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Xu S, Liang Y, Meng F, Zhu Z, Liu H. Risk prediction of degenerative scoliosis combined with lumbar spinal stenosis in patients with rheumatoid arthritis: a case-control study. Rheumatol Int 2020; 40:925-932. [PMID: 31919576 DOI: 10.1007/s00296-019-04508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this study is to compare incidence of degenerative scoliosis (DS) in patients who diagnosed lumbar spinal stenosis (LSS) with or without rheumatoid arthritis (RA) and identify the risk factors of DS severity in RA patients. 61 LSS patients with RA (RA group) and 87 demographic-matched LSS patients without RA (NoRA group) from January 2013 to April 2018 were enrolled. The extracted information includes RA-related parameters such as Steinbrocker classification, disease-modifying anti-rheumatic drugs (DMARDs), and DS-related information such as Cobb angle, apical vertebra, along with osteoporosis and history of total knee arthroplasty (TKA). Comparisons between RA and NoRA group and between DS and non-DS subgroup with RA were performed, as well as the risk factors on DS severity in RA patients. The incidence of DS in RA group was 42.6%, larger than that of NoRA group (P = 0.002). The mean Cobb angle between the two groups was of no difference (P = 0.076). The apical vertebrae were both mainly focused on L3 and L4 vertebrae in both groups with no significant difference on the distribution of apical vertebrae (P = 0.786). Female took a larger proportion in DS subgroup than that of NoDS subgroup in patients with RA (P = 0.039), while Steinbrocker classification was irrelevant to the occurrence of DS and Cobb angle. Multiple regression analysis showed that TKA was a risk factor for the severity of Cobb angle (P = 0.040). The incidence of DS in LSS patients with RA is higher than non-RA patients. RA patients performed TKA sustained less severity of DS.
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Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China
| | - Fanqi Meng
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China.
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Kirilov N, Kirilova E, Todorov S, Nikolov N. Effect of the lumbar scoliosis on the results of dual-energy X-ray absorptiometry. Orthop Rev (Pavia) 2020; 12:8477. [PMID: 32391137 PMCID: PMC7206360 DOI: 10.4081/or.2020.8477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
One of the most common causes of lumbar scoliosis in adults is the decreased bone mineral density (BMD). The scoliosis in the lumbar spine has a known effect over the dual-energy X-ray absorptiometry (DXA) scan results. The objective of this study is to assess the influence of the lumbar scoliosis on the results of the DXA scan of the lumbar spine. 1019 women aged ≥40 years underwent a DXA scan of the spine. Age, weight, height, total BMD, total Tscore of the lumbar spine were recorded. The angle of the lumbar scoliosis (Cobb’s angle) was measured from the DXA scan image using a DICOM software. The incidence of lumbar scoliosis in the current study accounts to 12.3%. Women with scoliosis showed significantly higher incidence of discrepancy in BMD T-scores between the adjacent vertebrae by more than 1 SD compared to women without scoliosis, (p=0.046). DXA results of subjects with scoliosis require more detailed evaluation of the T-scores of each vertebra to make a prompt decision about the final diagnosis.
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Affiliation(s)
| | - Elena Kirilova
- Department of Rheumatology, University Hospital "Dr. Georgi Stranski", Pleven, Bulgaria
| | | | - Nikolay Nikolov
- Department of Rheumatology, University Hospital "Dr. Georgi Stranski", Pleven, Bulgaria
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Dalle Ore CL, Ames CP, Deviren V, Lau D. Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis. J Neurosurg Spine 2019. [DOI: 10.3171/2018.11.spine18927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.
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Affiliation(s)
| | | | - Vedat Deviren
- Orthopedic Surgery, University of California, San Francisco, California
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Kashii M, Kanayama S, Kitaoka T, Makino T, Kaito T, Iwasaki M, Kubota T, Yamamoto T, Ozono K, Yoshikawa H. Development of scoliosis in young children with osteogenesis imperfecta undergoing intravenous bisphosphonate therapy. J Bone Miner Metab 2019; 37:545-553. [PMID: 30187275 DOI: 10.1007/s00774-018-0952-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/20/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to clarify the prevalence of scoliosis and determine risk factors for the development of scoliosis in young children with osteogenesis imperfecta (OI) who underwent intravenous pamidronate (PAM) therapy. Thirty-four young children with OI who had no scoliosis at the first PAM administration underwent cyclic PAM therapy alone. The medical records and radiographs of these patients were retrospectively reviewed. We examined the relationship between scoliosis (Cobb angle ≥ 10) and type of OI (Sillence classification: types I, III, and IV), physical mobility, Z-scores of bone mineral density in L2-4 of the lumbar spine (L2-4 BMD Z-scores), age of patients at first treatment with PAM, pelvic frontal tilt and leg-length discrepancy. The prevalence of scoliosis was 23.5% in 34 young children with OI who underwent PAM therapy for a mean of 4.2 years. Lower L2-4 BMD Z-scores, the presence of coronal and sagittal vertebral deformities and higher percentage of corrective osteotomy in the lower extremities were significant risk factors for the development of scoliosis. In patients with type III or IV OI, L2-4 BMD Z-scores were significantly lower (p = 0.02) and the percentage of patients who started PAM therapy in early childhood was significantly lower in scoliosis group than in the non-scoliosis group (p = 0.01). Development of scoliosis depends on the severity of OI and has a strong relationship with bone fragility even under PAM therapy. Starting intravenous PAM therapy in infancy or early childhood has a potential to prevent the occurrence and progression of scoliosis associated with bone fragility in young children with severe type III or IV OI.
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Affiliation(s)
- Masafumi Kashii
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Sadaaki Kanayama
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Taichi Kitaoka
- Department of Pediatrics, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takahiro Makino
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takuo Kubota
- Department of Pediatrics, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takehisa Yamamoto
- Department of Pediatrics, Minoh City Hospital, 5-7-1 Kayano, Minoh, Osaka, 562-0014, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Hagege B, Tubach F, Alfaiate T, Forien M, Dieudé P, Ottaviani S. Increased rate of lumbar spondylolisthesis in rheumatoid arthritis: A case-control study. Eur J Clin Invest 2018; 48:e12991. [PMID: 29956820 DOI: 10.1111/eci.12991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to compare the prevalence of lumbar spondylolisthesis (SPL) in patients suffering from low back pain (LBP) with or without rheumatoid arthritis (RA) and to identify potential factors associated with SPL in patients with RA. METHODS We performed a case-control study. Cases and control patients had chronic LBP (more than 4 weeks). Patient with RA fulfilled the 2010 ACR/EULAR criteria. The main outcome was the presence of lumbar SPL on lumbar X-ray. The prevalence of SPL between RA and control patients was compared using chi-squared test. Potential factors associated with SPL in patients with RA were investigated by univariate and multivariate analysis, estimating odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS A total of 67 cases and 83 controls were included. Median [interquartile range] age of patients with RA was 60.0 years [51.0-72.0]; 80.6% were females; and 92.5% and 83.6% were positive for anti-citrullinated protein antibodies (ACPAs) or rheumatoid factor, respectively. Mean RA disease duration was 11.2 ± 8.7 years. SPL was more frequent in patients with RA than controls (41.8% versus 18.1%, P = 0.001). Adjusted to gender, RA was associated with increased prevalence of SPL (OR 3.15 [95% CI 1.48-6.70], P = 0.003). Among patients with RA, SPL was mainly Grade 1 (85.7%). Multivariate analysis revealed SPL is associated with increased age in patients with RA (OR 1.06 [1.02-1.11], P = 0.004). CONCLUSION In a population of patients with chronic LBP, the prevalence of lumbar SPL was higher with than without RA. SPL might be explained by synovitis of lumbar facet joints.
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Affiliation(s)
- Benjamin Hagege
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Florence Tubach
- AP-HP, Département de Biostatistiques, Santé Publique et Informatique Médicale, Hôpital Pitié-Salpêtrière, Paris, France.,CIC-EC 1425, ECEVE UMR 1123, INSERM, Paris, France
| | - Toni Alfaiate
- AP-HP, Département d'Epidémiologie, Biostatistique et Recherche Clinique, Hôpital Bichat, Paris, France
| | - Marine Forien
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Philippe Dieudé
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sébastien Ottaviani
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Abstract
Low back pain (LBP) in patients with rheumatoid arthritis (RA) has so far been of little concern in clinical investigations. The main focus of scientific publications on spinal problems in RA was the cervical spine. In a recent study, we could demonstrate that LBP in RA patients leads to a significantly higher degree of disability and depression as well as to a reduction in quality of life compared to RA patients without LBP. If there is a specific reason for the additional symptom of LBP, such as spinal stenosis or segmental instability, surgical treatment may be indicated to improve disability and quality of life. For a successful outcome of spinal surgery it is important to address the specific aspects of RA patients, such as poor bone quality and the immunosuppressive effect of antirheumatic drug treatment. Whenever possible, minimally invasive surgical techniques should be used and the immunosuppressive medication should be stopped before surgery.
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Liu G, Tan JH, Ee G, Chan YH, Low SL, Wong HK. Morphology and Prevalence Study of Lumbar Scoliosis in 7,075 Multiracial Asian Adults. J Bone Joint Surg Am 2016; 98:1307-12. [PMID: 27489322 DOI: 10.2106/jbjs.15.00710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lumbar scoliosis affects patients' quality of life and will increasingly burden the health-care system as the population ages, yet there have been few reports of its prevalence in Asians. The aim of this study was to identify the prevalence of scoliosis, curve characteristics, and risk factors for development of scoliosis in an Asian population. METHODS A retrospective cross-sectional study was conducted using spinal images obtained from dual x-ray absorptiometry (DXA) scans of individuals ≥40 years of age. Scoliosis was defined as a curvature of >10°. A multivariate analysis for risk factors for development of lumbar scoliosis was performed. RESULTS Of 7,075 patients studied, 645 (9.1%) were identified as having scoliosis. The average age of the patients with scoliosis was 61 years (range, 40 to 98 years). The mean curve prevalence was 9.4% in women and 6.5% in men. The average Cobb angle was 16.5° (range, 10° to 66°). Multivariate analysis showed an increased risk of scoliosis in women (relative risk [RR] = 2.4, 95% CI =1.4 to 4.3), Chinese patients (RR = 2.4, 95% CI = 1.4 to 4.3), Malay patients (RR = 2.5, 95% CI = 1.3 to 4.9), and patients with spinal fracture (RR = 5.1, 95% CI = 3.0 to 8.8). The risk of scoliosis was found to increase as patients progressed through each decade of life after the age of 40 years (6th decade: RR = 1.6, 95% CI = 1.1 to 2.4, p = 0.026; 7th decade: RR = 2.7, 95% CI = 1.8 to 4.1, p < 0.001; 8th decade: RR = 5.0, 95% CI = 3.2 to 7.9, p < 0.001; and 9th decade: RR = 8.8, 95% CI = 4.3 to 17.9, p < 0.001). CONCLUSIONS The prevalence of lumbar scoliosis in Asian adults was found to be 9.1%. A nearly exponential increase in scoliosis prevalence from the 5th decade of life (4%) to the ≥9th decade (25%) and a majority of left-sided scoliotic curves, measuring between 10° and 19° with an L2 apex, was found. Older age, female sex, Chinese or Malay race, and vertebral fracture increased the risk of scoliosis developing. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gabriel Liu
- Department of Orthopaedic Surgery, University Spine Centre (G.L., J.H.T., G.E., and H.-K.W.) and Orthopaedic Diagnostic Centre (Y.H.C. and S.L.L.), National University Hospital, Singapore, National University Health System, Singapore
| | - Jun Hao Tan
- Department of Orthopaedic Surgery, University Spine Centre (G.L., J.H.T., G.E., and H.-K.W.) and Orthopaedic Diagnostic Centre (Y.H.C. and S.L.L.), National University Hospital, Singapore, National University Health System, Singapore
| | - Gerard Ee
- Department of Orthopaedic Surgery, University Spine Centre (G.L., J.H.T., G.E., and H.-K.W.) and Orthopaedic Diagnostic Centre (Y.H.C. and S.L.L.), National University Hospital, Singapore, National University Health System, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siew Leng Low
- Department of Orthopaedic Surgery, University Spine Centre (G.L., J.H.T., G.E., and H.-K.W.) and Orthopaedic Diagnostic Centre (Y.H.C. and S.L.L.), National University Hospital, Singapore, National University Health System, Singapore
| | - Hee-Kit Wong
- Department of Orthopaedic Surgery, University Spine Centre (G.L., J.H.T., G.E., and H.-K.W.) and Orthopaedic Diagnostic Centre (Y.H.C. and S.L.L.), National University Hospital, Singapore, National University Health System, Singapore
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Mochizuki T, Yano K, Ikari K, Hiroshima R, Takaoka H, Kawakami K, Koenuma N, Ishibashi M, Shirahata T, Momohara S. Scoliosis-related factors in patients with rheumatoid arthritis: A cross-sectional study. Mod Rheumatol 2015; 26:352-7. [PMID: 26395420 DOI: 10.3109/14397595.2015.1097016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study aimed to identify the prevalence of scoliosis and scoliosis-related factors of rheumatoid arthritis (RA). METHODS In this study, 411 patients who underwent coronal total spine and lower limb radiography were enrolled. Patients with a Cobb angle ≥10° were diagnosed with scoliosis. Statistical analysis was performed to compare between patients with and those without scoliosis, and between patients without scoliosis and those with a Cobb angle >20°. RESULTS The prevalence of scoliosis in patients with RA was 30.7%. The mean Cobb angles were 8.5° ± 7.2° in all the patients, 16.1° ± 8.6° in patients with scoliosis, and 5.1° ± 2.3° in patients without scoliosis. According to a multivariate analysis, the scoliosis-related factors of RA were age and vertebral fracture. Significant differences in age, corticosteroid use, and malalignment of lower limbs were observed between patients with a Cobb angle >20° and those without scoliosis. CONCLUSIONS With RA treatment, the need for corticosteroid use is reduced and vertebral fracture is prevented. Moreover, the joints and spinal and lower limb alignments should be examined.
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Affiliation(s)
- Takeshi Mochizuki
- a Department of Orthopaedic Surgery , Kamagaya General Hospital , Chiba , Japan
| | - Koichiro Yano
- b Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan , and
| | - Katsunori Ikari
- b Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan , and
| | - Ryo Hiroshima
- a Department of Orthopaedic Surgery , Kamagaya General Hospital , Chiba , Japan
| | - Hiromitsu Takaoka
- a Department of Orthopaedic Surgery , Kamagaya General Hospital , Chiba , Japan
| | - Kosei Kawakami
- a Department of Orthopaedic Surgery , Kamagaya General Hospital , Chiba , Japan
| | - Naoko Koenuma
- a Department of Orthopaedic Surgery , Kamagaya General Hospital , Chiba , Japan
| | - Mina Ishibashi
- a Department of Orthopaedic Surgery , Kamagaya General Hospital , Chiba , Japan
| | - Toshikatsu Shirahata
- c Department of Orthopaedic Surgery , Chibanishi General Hospital , Chiba , Japan
| | - Shigeki Momohara
- b Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan , and
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Sugimura Y, Miyakoshi N, Miyamoto S, Kasukawa Y, Hongo M, Shimada Y. Prevalence of and factors associated with lumbar spondylolisthesis in patients with rheumatoid arthritis. Mod Rheumatol 2015; 26:342-346. [DOI: 10.3109/14397595.2015.1081326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yusuke Sugimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Seiya Miyamoto
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Mesfin A, El Dafrawy MH, Jain A, Hassanzadeh H, Kostuik JP, Lemma MA, Kebaish KM. Surgical outcomes of long spinal fusions for scoliosis in adult patients with rheumatoid arthritis. J Neurosurg Spine 2015; 22:367-73. [DOI: 10.3171/2014.10.spine14365] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
In this study, the authors compared outcomes and complications in patients with and without rheumatoid arthritis (RA) who underwent surgery for spinal deformity.
METHODS
The authors searched the Johns Hopkins University database for patients with RA (Group RA) and without RA (Group NoRA) who underwent long spinal fusion for scoliosis by 3 surgeons at 1 institution from 2000 through 2012. Groups RA and NoRA each had 14 patients who were well matched with regard to sex (13 women/1 man and 12 women/2 men, respectively), age (mean 66.3 years [range 40.5–81.9 years] and 67.6 years [range 51–81 years]), follow-up duration (mean 35.4 months [range 1–87 months] and 44 months [range 24–51 months]), and number of primary (8 and 8) and revision (6 and 6) surgeries. Surgical outcomes, invasiveness scores, and complications were compared between the groups using the nonpaired Student t-test (p < 0.05).
RESULTS
For Groups RA and NoRA, there were no significant differences in the average number of levels fused (10.6 [range 9–17] vs 10.3 [range 7–17], respectively; p = 0.4), the average estimated blood loss (2892 ml [range 1300–5000 ml] vs 3100 ml [range 1700–5200 ml]; p = 0.73), or the average invasiveness score (35.5 [range 21–51] vs 34.5 [range 23–58]; p = 0.8). However, in Group RA, the number of major complications was significantly higher (23 vs 11; p < 0.001), the number of secondary procedures was significantly higher (14 vs 6; p < 0.001), and the number of minor complications was significantly lower (4 vs 12; p < 0.001) than those in Group NoRA.
CONCLUSIONS
Long spinal fusion in patients with RA is associated with higher rates of major complications and secondary procedures than in patients without RA.
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Affiliation(s)
- Addisu Mesfin
- 1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and
| | - Mostafa H. El Dafrawy
- 1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and
| | - Amit Jain
- 1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and
| | - Hamid Hassanzadeh
- 2Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - John P. Kostuik
- 1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and
| | - Mesfin A. Lemma
- 1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and
| | - Khaled M. Kebaish
- 1Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and
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Thoracic scoliosis prevalence in patients 50 years or older and its relationship with age, sex, and thoracic kyphosis. Spine (Phila Pa 1976) 2014; 39:149-52. [PMID: 24153170 DOI: 10.1097/brs.0000000000000095] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To determine the prevalence of thoracic scoliosis in patients aged 50 years or older and to investigate the association of adult thoracic scoliosis with age, sex, and thoracic sagittal curve. SUMMARY OF BACKGROUND DATA The prevalence of adult thoracic scoliosis has not been clearly determined. In addition, limited data are available on the correlation of adult thoracic scoliosis to age, sex, and thoracic kyphosis. METHODS We studied 760 patients aged 50 years or older (380 males and 380 females) who were evaluated using standing chest plain radiographs. The thoracic curvatures in the coronal and sagittal planes were measured using the Cobb method. Scoliosis was defined by the presence of a coronal curvature 10° or more. We performed a correlation analysis of the coronal curve with age and sagittal curve; in addition, a linear regression analysis was carried out to evaluate age, sex, and sagittal curve as independent predictors of the coronal Cobb angle of the thoracic spine. RESULTS The prevalence of thoracic scoliosis was 24.2% (184 cases); 160 patients (21.1%) had curves 10° or more but less than 20°; 20 patients (2.6%) had curves 20° or more but less than 30°; and 4 patients (0.5%) had curves 30° or more. Females exhibited a higher prevalence of scoliosis (28.9%) than did males (19.4%), P < 0.01. The older patients exhibited increased scoliosis, but no differences were observed in thoracic kyphosis with increasing scoliosis. Age and sex were independent predictors of the coronal Cobb angle; however, the sagittal angle was not. CONCLUSION We found a 24.2% prevalence of thoracic scoliosis in patients 50 years or older; most curves were less than 20°. Thoracic scoliosis was more common in females and in older patients. LEVEL OF EVIDENCE 3.
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