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Obesity Is Associated With Increased Thoracic Kyphosis in Adolescent Idiopathic Scoliosis Patients and Nonscoliotic Adolescents

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Abstract

Study Design

Retrospective comparative cohort study.

Objective

To compare radiographic parameters between adolescents with a greater body mass index (BMI) percentile to underweight individuals.

Summary of Background Data

Increased BMI percentile has been associated with increased complications after surgical correction of adolescent idiopathic scoliosis (AIS). However, association between BMI percentile and preoperative sagittal plane alignment has not been evaluated. The purpose of this study was to evaluate the effect of BMI percentile on sagittal alignment in AIS patients compared with nonscoliotic adolescents.

Methods

Posterior-anterior and lateral spinal radiographs of 1,551 AIS patients with a thoracic major curve (Lenke 1–4) and 70 nonscoliotic adolescent patients were compared. BMI percentile was determined based on age and sex, and patients were divided into four categories: underweight (<5th percentile), normal-weight (5th–85th percentile), overweight (85th–95th percentile), and obese (≥95th percentile).

Results

Coronal plane deformity magnitude was not significantly different between the 4 categories of AIS patients (p = .51). Increased BMI percentile was associated with increased thoracic kyphosis globally (T2–T12: p < .005) as well as segmentally (T2–T5: p < .001; T5–T12: p < .001) in patients with AIS. This was also true in obese adolescents without spinal deformity (p < .04). Lumbar lordosis, pelvic incidence, and pelvic tilt were not significantly different between AIS patients in the four BMI percentile categories (p > .07). Pelvic incidence was significantly greater in AIS patients compared with nonscoliotic adolescents (54 ± 13 vs. 46 ± 11; p = .01).

Conclusion

Increased BMI percentile is associated with increased thoracic kyphosis in AIS patients and nonscoliotic adolescents. Excess weight may reduce anterior vertebral growth. AIS patients have an increased pelvic incidence compared with nonscoliotic adolescents; however, this variable is not influenced by body mass. These relationships should be taken into account when planning sagittal plane deformity correction or considering neuro axis disorders (also associated with increased kyphosis) in patients with scoliosis.

Level of Evidence

Level II.

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Author information

Authors and Affiliations

  1. University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0021, USA

    Alan G. Valdovino BS & Vidyadhar V. Upasani MD

  2. Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, 3020 Children’s Way, San Diego, CA, 92123, USA

    Tracey P. Bastrom MA, Fredrick G. Reighard MPH, Madeline Cross MPH, Carrie E. Bartley MA, Burt Yaszay MD, Peter O. Newton MD & Vidyadhar V. Upasani MD

  3. Department of Orthopedics, Nemours Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Suken A. Shah MD

  4. Rady Children’s Hospital San Diego, 3030 Children’s Way, San Diego, CA, 92123, USA

    Vidyadhar V. Upasani MD

Authors
  1. Alan G. Valdovino BS
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  2. Tracey P. Bastrom MA
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  3. Fredrick G. Reighard MPH
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  4. Madeline Cross MPH
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  5. Carrie E. Bartley MA
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  6. Suken A. Shah MD
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  7. Burt Yaszay MD
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  8. Peter O. Newton MD
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  9. Vidyadhar V. Upasani MD
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Corresponding author

Correspondence to Vidyadhar V. Upasani MD.

Additional information

This study was conducted at Rady Children’s Hospital, San Diego, CA.

Author disclosures: AGV (none), TPB (a Surgical Department grant from Rady Children’s Specialists of San Diego; research grants to the Setting Scoliosis Straight Foundation from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive, and Zimmer Biomet., during the conduct of the study), FGR (none), MC (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), CEB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), SAS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine, NuVasive, and K2M, outside the submitted work), BY (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M, DePuy Synthes Spine, and NuVasive; personal fees from Medtronic, Orthopediatrics, Stryker, and Globus; grants from Setting Scoliosis Straight Foundation; personal fees from Biogen and Ethicon, outside the submitted work; in addition, BY has a patent K2M with royalties paid), PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation and Scoliosis Research Society; other from Rady Children’s Specialists; grants, personal fees, and nonfinancial support from DePuy Synthes Spine; grants from EOS Imaging and from NuVasive; other from Electrocore; personal fees from Cubist and Thieme Publishing; other from International Pediatric Orthopedic Think Tank, grants, nonfinancial support, and other from Orthopediatrics; grants, personal fees, and nonfinancial support from K2M; grants and nonfinancial support from Alphatech; grants from Mazor Robotics, outside the submitted work; in addition, PON has a patent “Anchoring Systems and Methods for Correcting Spinal Deformities” (8540754) with royalties paid to DePuy Synthes Spine, a patent “Low Profile Spinal Tethering Systems” (8123749) licensed to DePuy Spine, Inc., a patent “Screw Placement Guide” (7981117) licensed to DePuy Spine, Inc., a patent “Compressor for Use in Minimally Invasive Surgery” (7189244) licensed to DePuy Spine, Inc., and a patent “Posterior Spinal Fixation” pending to K2M), VVU (personal fees from Orthopediatrics and DePuy Synthes Spine, outside the submitted work). We gratefully acknowledge research support from grants from the following: a Surgical Department grant from Rady Children’s Specialists of San Diego; (2) research grants to the Setting Scoliosis Straight Foundation from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive, and Zimmer Biomet. Harms Study Group Investigators: Aaron Buckland, MD, New York University; Amer Samdani, MD, Shriner’s Hospital for Children—Philadelphia; Amit Jain, MD, Johns Hopkins Hospital; Baron Lonner, MD, Scoliosis and Spine Associates; Benjamin Roye, MD, Columbia University; Burt Yaszay, MD, Rady Children’s Hospital; Chris Reilly, MD, BC Children’s Hospital; Daniel Hedequitst, MD, Boston Children’s Hospital; Daniel Sucato, MD, Texas Scottish Rite Hospital; David Clements, MD, Cooper Bone & Joint Institute New Jersey; Firoz Miyanji, MD, BC Children’s Hospital; Harry Shufflebarger, MD, Nicklaus Children’s Hospital; Jack Flynn, MD, Children’s Hospital of Philadelphia; Jahangir Asghar, MD, Cantor Spine Institute; Jean Marc Mac Thiong, MD, CHU Sainte-Justine; Joshua Pahys, MD, Shriner’s Hospital for Children–Philadelphia; Juergen Harms, MD, Klinikum Karlsbad-Langensteinbach, Karlsbad; Keith Bachmann, MD, University of Virginia; Larry Lenke, MD, Columbia University; Mark Abel, MD, University of Virginia; Michael Glotzbecker, MD, Boston Children’s Hospital; Michael Kelly, MD, Washington University; Michael Vitale, MD, Columbia University; Michelle Marks, PT, MA, Setting Scoliosis Straight Foundation; Munish Gupta, MD, Washington University; Nicholas Fletcher, MD, Emory University; Patrick Cahill, MD, Children’s Hospital of Philadelphia; Paul Sponseller, MD, Johns Hopkins Hospital; Peter Gabos, MD, Nemours/Alfred I. duPont Hospital for Children; Peter Newton, MD, Rady Children’s Hospital; Peter Sturm, MD, Cincinnati Children’s Hospital; Randal Betz, MD, Institute for Spine & Scoliosis; Ron Lehman, MD, Columbia University; Stefan Parent, MD, CHU Sainte-Justine; Stephen George, MD, Nicklaus Children’s Hospital; Steven Hwang, MD, Shriner’s Hospital for Children–Philadelphia; Suken Shah, MD, Nemours/Alfred I. duPont Hospital for Children; Tom Errico, MD, Nicklaus Children’s Hospital; Vidyadhar Upasani, MD, Rady Children’s Hospital.

IRB approval: IRB approval was obtained for this study from the University of California San Diego.

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Valdovino, A.G., Bastrom, T.P., Reighard, F.G. et al. Obesity Is Associated With Increased Thoracic Kyphosis in Adolescent Idiopathic Scoliosis Patients and Nonscoliotic Adolescents. Spine Deform 7, 865–869 (2019). https://doi.org/10.1016/j.jspd.2019.03.010

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  • DOI: https://doi.org/10.1016/j.jspd.2019.03.010

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