Tsutomu Akazawa1, Kota Watanabe2, Morio Matsumoto2, Taichi Tsuji3, Noriaki Kawakami4, Toshiaki Kotani5, Tsuyoshi Sakuma5, Takuya Yamamoto6, Satoru Demura7, Sumihisa Orita8, Kazuki Fujimoto8, Yasuhiro Shiga8, Hisateru Niki9. 1. Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan; Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan. Electronic address: cds00350@par.odn.ne.jp. 2. Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan. 3. Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan; Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan. 4. Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan. 5. Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan. 6. Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. 7. Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan. 8. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 9. Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Abstract
BACKGROUND: We have yet to determine what types of lumbar degenerative changes can be observed on MRI in middle-aged adolescent idiopathic scoliosis (AIS) patients without undergoing surgery. The aims of this study were to investigate AIS patients who have reached middle age without undergoing surgery and to clarify if residual spinal deformities may have affected health-related quality of life (HRQOL) and lumbar spine degeneration. METHODS: Subjects comprised AIS patients who reached middle age without surgery and who underwent whole-spine X-rays, lumbar MRI, and SRS-22 surveys. Of the 60 cases collected from five scoliosis centers, 25 patients who met the inclusion criteria were enrolled into the residual deformity (RD) group and analyzed. Controls (CTR) group comprised 25 individuals matched for age, sex, and BMI with the patient group. RESULTS: MRI revealed no significant differences in the percentage of individuals with Pfirrmann grade 4 or 5 disc degeneration in 1 or more segments (RD group: 84%, CTR group: 60%, p = 0.059). Significantly more patients with Modic changes in 1 or more segments were observed in the RD group (RD group: 56%, CTR group: 8%, p < 0.001). All SRS-22 scores were significantly lower in the RD group. The lumbar curve cutoff point based on whether or not Modic change could be observed using ROC analysis was 39.5°. CONCLUSIONS: Compared to healthy individuals, AIS patients with residual deformity who have never had surgery showed similar prevalence of disc degeneration, but they had more Modic changes and poor HRQOL. The cutoff point for lumbar curves of patients with and without Modic changes in middle age was 39.5°.
BACKGROUND: We have yet to determine what types of lumbar degenerative changes can be observed on MRI in middle-aged adolescent idiopathic scoliosis (AIS) patients without undergoing surgery. The aims of this study were to investigate AISpatients who have reached middle age without undergoing surgery and to clarify if residual spinal deformities may have affected health-related quality of life (HRQOL) and lumbar spine degeneration. METHODS: Subjects comprised AISpatients who reached middle age without surgery and who underwent whole-spine X-rays, lumbar MRI, and SRS-22 surveys. Of the 60 cases collected from five scoliosis centers, 25 patients who met the inclusion criteria were enrolled into the residual deformity (RD) group and analyzed. Controls (CTR) group comprised 25 individuals matched for age, sex, and BMI with the patient group. RESULTS: MRI revealed no significant differences in the percentage of individuals with Pfirrmann grade 4 or 5 disc degeneration in 1 or more segments (RD group: 84%, CTR group: 60%, p = 0.059). Significantly more patients with Modic changes in 1 or more segments were observed in the RD group (RD group: 56%, CTR group: 8%, p < 0.001). All SRS-22 scores were significantly lower in the RD group. The lumbar curve cutoff point based on whether or not Modic change could be observed using ROC analysis was 39.5°. CONCLUSIONS: Compared to healthy individuals, AISpatients with residual deformity who have never had surgery showed similar prevalence of disc degeneration, but they had more Modic changes and poor HRQOL. The cutoff point for lumbar curves of patients with and without Modic changes in middle age was 39.5°.