Is Obesity in Adolescent Idiopathic Scoliosis Associated with Larger Curves and Worse Surgical Outcomes?

Li, Ying; Binkowski, Laura; Grzywna, Alexandra; Robbins, Christopher; Caird, Michelle S.; Farley, Frances A.; Yen, Yi‐Meng; Glotzbecker, Michael P.

doi:10.1542/peds.141.1_meetingabstract.630

Cited by 4 publications

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“…Fourth, adolescents in this cohort were screened with the Adams' forward bend test which is less sensitive in overweight and obese individuals. [35][36][37] To address this limitation, we conducted a multivariable logistic regression model adjusted for weight status and odds ratios remained unchanged (Figure 2). Fifth, our records did not allow subgroup analyses of adolescents with adolescent spinal scoliosis and Scheuermanns kyphosis.…”

Section: Discussionmentioning

confidence: 99%

“…Third, our records did not allow distinct subgroup analyses for adolescent spinal scoliosis and Scheuermann kyphosis. Fourth, adolescents in this cohort were screened with the Adams’ forward bend test which is less sensitive in overweight and obese individuals 35–37 . To address this limitation, we conducted a multivariable logistic regression model adjusted for weight status and odds ratios remained unchanged (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

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The Hereditary Nature of Adolescent Spinal Deformities

Zloof

Ankory

Braun

et al. 2022

Spine

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Study Design. A cross-sectional study.Objective. We designed this study to investigate the risk for spinal deformity among individuals whose parents had a spinal deformity. Summary of Background Data. Adolescent idiopathic scoliosis and Scheuermann kyphosis are common adolescent spinal deformities (ASD) with a significant impact on public health. Timely treatment with bracing is effective in halting or slowing the progression of these deformities. However, screening healthy adolescents for spinal deformities remains debatable. While the leading medical organizations endorse contradictory positions regarding the screening of the general population, there is a consensus that screening of targeted population should be considered. Due to their genetic predisposition, adolescents whose parents suffer from a spinal deformity may be candidates for targeted screening. Methods. We conducted a nationwide, population-based study of 611,689 Israeli adolescents, aged 16 to 19 years old, who were screened for spinal deformities between the years 2000 and 2019. The data for this study were derived from a central database containing medical records of all adolescents who were examined preliminary to mandatory military service. In our study, ASD were strictly defined by plain x-ray.Results. Compared with adolescents whose parents did not have a spinal deformity, the odds ratios (OR) for ASD among adolescents whose father, mother, or both parents had spinal deformity were 1.46, 1.74, and 2.58, respectively. These ratios were consistent in multivariate models. Conclusion. We have found a considerable increased risk for adolescent spinal deformities among adolescents whose parents suffered from spinal deformities. We believe that our findings should serve the leading medical organizations when considering the screening of targeted populations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Hereditary Nature of Adolescent Spinal Deformities

Zloof

Ankory

Braun

et al. 2022

Spine

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“…The increased initial average curve magnitude and greater risk of severe curves in girls seen in our cohort confirms some of the previous literature on curve magnitude based on sex. 11,12,17,21,42 In regard to the association of BMI/weight and curve magnitude, some previous studies have suggested obese patients have a higher initial curve magnitude at presentation, [51][52][53][54][55] by assessing curve size based on BMI compared to BMI of the population at large, or by comparing curve size relative to BMI only in patients with scoliosis (ie, without comparative normal/control populations). The present study, however, assesses risks based on sex and BMI in a detailed, stepwise manner based on each weight class and uses a large control population of nearly 1 million children to assess both the OR of IS, and the risk of severe curves, based on BMI.…”

Section: Discussionmentioning

confidence: 99%

The Demographics and Epidemiology of Infantile, Juvenile, and Adolescent Idiopathic Scoliosis in a Southern California Integrated Health Care System

Bondar

Nguyen

Vatani

et al. 2021

Spine

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Study Design. Prognostic study, Level III. Objectives. The aim of this study was to determine the incidence and demographics of idiopathic scoliosis (IS) in a large cohort of children in a Southern California integrated healthcare system, and to identify the demographic or clinical factors associated with the greatest risk of IS. Summary of Background Data. Although many authors have reported on the incidence and prevalence of IS in children, there have been few incidence studies in the United States on large, self-contained populations. Methods. A retrospective chart analysis was done on diagnosed cases of IS within our integrated health care system in patients under age 18 years during the entire 2013 calendar year. Patient demographics were recorded and the incidence of IS was determined. Odds ratios (ORs) for having IS and for having more severe initial curve magnitudes based on demographics were determined using logistic regression models. Results. IS Incidence was 3.9, 28.6, and 393 per 100,000, respectively, for the infantile, juvenile, and adolescent group. The female incidence was more than twice that of males in all age groups. Multivariate logistic regression analysis showed Asians and non-Hispanic Whites had the highest OR of IS (OR 1.54 and 1.32 with 95% confidence interval [CI] 1.33-1.79 and 1.19-1.47). Whites, Blacks, and mixed-race patients had a significantly higher initial curve magnitude than Hispanics; females also had a significantly greater initial curve magnitude than boys (18.18 vs. 16.78). Underweight patients had a 50% increased OR of IS versus normal weight (95% CI 1.16-1.94) with a progressively decreased OR of IS as weight increased. Conclusion. Our study of a large integrated healthcare system sheds light on the incidence of IS and the ORs based on weight, sex, and ethnicity/race. The overall incidence was lower overall than previously thought.

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“…Given that there is some evidence to suggest that shoulder imbalance is worse in larger thoracic curves [9], and given that overweight and obese patients with AIS present with larger thoracic curves at initial visit [1][2][3][4], we hypothesized that overweight and obese children would present with worse shoulder imbalance on initial visit. Indeed, we found that overweight and obese children were almost twice as likely to present on initial visit with unbal- anced shoulders (OR 1.97; 95% CI: 1.02-3.83).…”

Section: Discussionmentioning

confidence: 99%

“…Childhood obesity is an epidemic in the USA, with many downstream effects on the musculoskeletal system. For patients with adolescent idiopathic scoliosis (AIS), the recent literature has revealed that obese children may have larger curves on initial presentation [1][2][3][4], may fail brace treatment more often [1,5], experience longer operative times for surgical treatment of their spine deformities, and suffer from a higher rate of surgical site infections [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Does Obesity Affect Preoperative Shoulder Balance in Adolescent Idiopathic Scoliosis?

et al. 2021

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Background: Obese patients with adolescent idiopathic scoliosis (AIS) have been shown to present with larger curve magnitudes preoperatively. However, the effect of obesity on shoulder balance in AIS remains unknown. The purpose of our study was to determine if overweight and obese patients with AIS have worse radiographic shoulder balance on initial presentation when compared with normal weight patients. Methods: AIS patients <18 years old, with Lenke 1 or 2 curves, who underwent a posterior spinal fusion between March 2013 and December 2018 were retrospectively evaluated. BMI-for-age percentiles as defined by the Center for Disease Control and Prevention were used: obese (≥95th percentile), overweight (85th to <95th percentile), and normal weight (5th to <85th percentile). Shoulder height was measured via the radiographic shoulder height (RSH) method, with an RSH ≤ 1 cm considered balanced. The primary outcome was preoperative shoulder balance. Secondary outcomes included postoperative shoulder balance, major curve correction, and UIV selection. Results: One hundred eighty-four patients (116 [63%] normal weight and 68 [37%] overweight/obese) were included. The mean age at surgery was 13.1 ± 2 years, and mean follow-up was 17.4 ± 13 months. Preoperative shoulder imbalance was significantly greater in the overweight/obese group compared to the normal weight group (1.9 ± 1 cm vs. 1.5 ± 1 cm, p = 0.04). The odds ratio of presenting with unbalanced shoulders was 2.0 (95% CI: 1.02–3.83, p = 0.04) for the overweight/obese group. No significant differences were found for postoperative shoulder balance, UIV selection, or major curve correction. Conclusions: Overweight and obese patients with AIS are twice as likely to present with unbalanced shoulders preoperatively; however, this difference is not clinically relevant with a mean difference of 0.4 cm between cohorts. Finally, the preoperative BMI percentile did not show a significant effect on the chosen UIV or curve magnitude correction. Level of Evidence: Level III: this is a retrospective case-control study.

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Is Obesity in Adolescent Idiopathic Scoliosis Associated with Larger Curves and Worse Surgical Outcomes?

Cited by 4 publications

References 0 publications

The Hereditary Nature of Adolescent Spinal Deformities

The Hereditary Nature of Adolescent Spinal Deformities

The Demographics and Epidemiology of Infantile, Juvenile, and Adolescent Idiopathic Scoliosis in a Southern California Integrated Health Care System

Does Obesity Affect Preoperative Shoulder Balance in Adolescent Idiopathic Scoliosis?

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