Radiographic and clinical analyses of scoliosis of adult subjects in the greater Durban area
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Aim: To determine a radiographic and clinical profile of adult subjects with scoliosis and to determine an association between selected radiographic and clinical parameters. Subjects: Sixty subjects between 18 and 45 years, with or without neck/back pain, previously diagnosed with scoliosis. Methodology: A case history and a physical examination of the subject which included an orthopedic assessment of the cervical, thoracic and lumbar spinal areas were conducted for all subjects. Selected clinical data viz. a case history, family history, level and location of pain if present, presence of leg length inequality, pelvic obliquity, shoulder height inequality and/or rib hump was recorded. A full spine A-P radiograph was taken for each subject in the weight-bearing position. Selected radiographic parameters viz. location of curve/s, side of convexity, degree of pedicle rotation, level of the apex vertebra and the Cobb angle of inclination were assessed and recorded. SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA) was used for data analysis. Results: The mean (± SD) age of the subjects was 26.8 (± 7.9) years. The majority of the subjects were females (63.3 %). A family history of scoliosis was reported by 14 subjects. Most of the subjects (73.3%) complained of pain of moderate severity at the time of presentation. The thoracic and lumbar regions were common areas of complaint in symptomatic subjects and they were most likely to experience pain at the level of the apex vertebra. Shoulder height inequality was observed in 96.7% of subjects, LLI in 91.7% of subjects, rib hump in 73.3% of subjects and pelvic obliquity in 86.7% of subjects. The majority of scoliotic curves were of idiopathic origin (96.7%). Thirty subjects presented with more than one curve. The mean (± SD) Cobb angle for the major curve was 21.3º (± 13.1º) while the mean (± SD) Cobb measurement for the minor curve was 16.7º (± 5.4º). The range for the major and minor curve was 11.5º - 97.0º and 10º- 37º respectively. Both the major and minor curve had the majority of curves located in the thoracic region. However, the apex vertebra was most likely to be found in the T7/T8 region for the major curve and L1/2 region for the minor curve. Pedicle rotation was Grade 1, Grade 0 or Grade 2 (in that order) for the major curves and Grade 0, Grade1 and Grade 2 for the minor iv curves. There was no significant association between the gender of the patient and the severity of pain (p = 0.725), severity of the major curve (p = 0.545) or grade of pedicle rotation (p = 0.639). There was also no significant association between the ethnicity of the subjects and severity of the major curve (p = 0.088) or degree of pedicle rotation (p = 0.882). No significant association was found between location of the major curve and presence of pain (p = 0.565) or between the side of the curve and pain (p = 0.812). There was no correlation between the degree of pain and the degree of curve (r = 0.102). No significant association was found between LLI and degree of curvature (p = 0.470). A significant association between LLI and reported pain was found (p = 0.034). A significant association was observed between the presence of a rib hump and the degree of curvature (p = 0.049). A positive correlation was found between rib hump elevation and degree of curvature (r = 0.814). A positive correlation between rib hump elevation and degree of pedicle rotation was found (rho = 0.308). Conclusion: Idiopathic scoliosis is the most common form of scoliosis in young adults. Pain is a common clinical feature in adult scoliosis. The size of the curve does not influence the magnitude of the LLI, pelvic obliquity or shoulder height inequality, however since these clinical features are common findings in the scoliotic individual, it is suggested that these parameters be routinely evaluated for their diagnostic significance. The presence of shoulder height inequality, LLI, rib hump and pelvic obliquity are deemed to be good clinical signs of scoliosis. Even though LLI was not associated with the magnitude of the curve, it may be a significant contributor to the back pain as LLI was found to be the only clinical parameter to have a significant association with pain. Therefore clinicians should explore the treatment of LLI to alleviate pain associated with scoliosis. The presence of a rib hump is a good clinical indication of the presence of a scoliosis.