Obesity May Delay Detection of Scoliosis

By Will Boggs MD

NEW YORK (Reuters Health) - Obese patients present to orthopedic surgeons with greater scoliosis curve magnitudes than non-obese patients, according to a new study.

"This may be because their body type makes detection by physical exam harder," Dr. Shawn R. Gilbert, from University of Alabama at Birmingham, told Reuters Health by email.

Surface topography, asymmetry of the Adam forward bend test, waist or shoulder asymmetry, and trunk shift-the typical components evaluated in screening programs for scoliosis-could be obscured by obesity.

If that happened, Dr. Gilbert's team reasoned that obesity would be associated with increased curve magnitude at initial presentation for evaluation of scoliosis. They tested their hypothesis through a chart review of 180 patients referred to Children's Hospital of Alabama for evaluation of scoliosis.

Although the correlations were not strong, there was a linear relationship between body mass index (BMI) and the magnitude of curvature at presentation for thoracic curves (r=0.19, p=0.03) and lumbar curves (r=0.24, p=0.02), according to the May 11 Pediatrics online report.

Obese and overweight patients did not differ significantly from normal-weight patients in the proportion who presented with curves of a surgical magnitude (>45 degrees) or in the proportion who ultimately underwent surgical intervention.

Mean curve magnitudes did not differ significantly between black and white patients or between those with private insurance and those with Medicaid or self-pay, but thoracic curve magnitude was lower among those with higher median family income.

BMI and BMI percentile were not associated with race, sex, or insurance status.

"I should also point out what we are not saying," Dr. Gilbert said. "We cannot tell whether obese kids are more likely to get scoliosis or if they are more likely to progress. Also, we are not able to tell whether treatment should be any different or if outcomes are altered."

The researchers suggest, "To avoid possible delays in detection due to obscuration of body contours by increased BMI, scoliosis screeners may wish to emphasize elements of the physical examination less obscured by girth, such as shoulder height asymmetry or the use of a scoliometer."

Dr. Manuel Ramirez, from Vall d'Hebron Hospital's Spine Unit, Barcelona, Spain, has had a different experience. He told Reuters Health by email, "In my works, this relationship between BMI and magnitude of the curve is not found. We showed that there is a percentage of AIS (adolescent idiopathic scoliosis) girls with low BMI greater than the normal population, and this data is a prognostic factor in patients operated. The patients with low BMI have worse outcomes than patients with normal BMI."

"Probably we need more studies, with greater series to confirm if BMI is related to curve magnitude," Dr. Ramirez said.

The authors reported no funding of conflicts of interest.

SOURCE: http://bit.ly/1F9cR8r

Pediatrics 2015.

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