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Scoliosis in Adults Aged Forty Years and Older: Prevalence and Relationship to Age, Race, and Gender

Kebaish, Khaled M. MD; Neubauer, Philip R. MD; Voros, Gabor D. MD; Khoshnevisan, Mohammad A. BS; Skolasky, Richard L. ScD

doi: 10.1097/BRS.0b013e3181e9f120

Study Design. Retrospective study.

Objective. To identify the prevalence of lumbar scoliosis in adults ≥40 years old; to investigate relationships between scoliosis prevalence and 3 parameters (age, race, gender); and to determine any effect of those parameters on curve severity.

Summary of Background Data. As the population ages, the incidence of degenerative spine conditions increases. More patients are being diagnosed with and treated for spinal deformities, including scoliosis.

Methods. We examined dual-energy x-ray absorptiometry lumbar spine images of 3185 individuals ≥40 years old (average, 60.8 years; range, 40–97 years), obtained July 2002 to June 2005, to determine the presence of scoliosis (i.e., a curvature of ≥11.0°) by digitally measuring Cobb angles. Patients with a history of previous lumbar spinal surgery were excluded, leaving 2973 individuals for final evaluation. We used SAS system software, version 9.1 (SAS Institute, Inc., Cary, NC) to investigate the relationship between the prevalence of scoliosis and the variables of age, race, and gender, we then examined for any effect that these variables had on curve severity.

Results. We identified scoliosis (i.e., a Cobb angle of ≥11°) in 263 of 2973 patients. Age was associated with an increased prevalence of scoliosis, e.g., 40 to 50 years old, 3.14%; ≥90 years old, 50%. Prevalence rates differed among races (e.g., 11.1% for whites and 6.5% for African Americans) but were similar for men and women. Most patients had mild curves (80.6%), there was no difference in the distribution of curve severity by gender or age, and African Americans were more likely to have mild curves (94.3%) than were other races.

Conclusion. The prevalence of scoliosis in our patients ≥40 years old was 8.85% and was associated with age and race, but not with gender. Most curves in our population were mild; curve severity was associated with race but not with age or gender.

We reviewed the lumbar spine dual energy x-ray absorptiometry scans of 2973 individuals aged [mtequ]40 years and found that the prevalence of scoliosis was 8.85%; that scoliosis was associated with age (almost linear relationship) and race, but not with gender; and that curve severity associated with race but not with age or gender.

From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Khaled M. Kebaish, MD, c/o Elaine P. Henze, BJ, ELS, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, A665, Baltimore, MD 21224–2780; E-mail:

Acknowledgment date: December 29, 2008. First revision date: September 1, 2009. Second revision date: February 23, 2010. Acceptance date: February 28, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Professional Organization funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.