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The Impact of Adult Scoliosis on the Cervical Spine: Paper #29

Glassman, Steven D. MD; Carreon, Leah Y. MD, MSc; Schwab, Frank J. MD; Shaffrey, Christopher I. MD; Hu, Serena S. MD; Bridwell, Keith H. MD

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Spine Journal Meeting Abstracts: 2010 - Volume - Issue - p 68
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Summary: In a cohort of 1721 adult scoliosis patients, 420 (24.4%) had neck complaints. A more proximal Upper End Vertebra was predictive of the presence of neck pain complaints. The data suggests that an increased focus on the relationship between adult scoliosis and cervical spine pathology is warranted. It seems reasonable to presume that, analogous to the situation in the lumbar spine, degenerative changes in the cervical spine may impact the clinical course of an adult spinal deformity, and visa versa.

Introduction: Assessment of adult scoliosis typically involves evaluation of both the primary deformity and the lumbar spine. In contrast, little attention has been devoted to the impact of adult scoliosis or treatment on the cervical spine. The purpose of this study is to assess the frequency of cervical spine complaints in an adult scoliosis population, and to determine whether radiographic characteristics of the spinal deformity predict cervical symptoms.

Methods: We reviewed a cohort of adult scoliosis patients entered in a prospective data base of adult spinal deformity. Patients who indicated that their neck bothered them or limited their function were identified. Student's t‐tests were used to determine any difference in continuous variables between patients who complained of neck pain and those that did not. Fisher's exact test was used to determine any difference in categorical variables between the groups. Binary regression analysis was done to determine factors predictive of the presence of neck complaints.

Results: 420 (24.4%) of 1721 patients included in the analysis had neck pain. Neck pain complaints were statistically greater in patients aged 40 to 60 years old (29.3%), followed by 18 to 39 years old (25.1%) and those older than 60 years (18.5%). A statistically greater proportion of patients who had neck pain were smokers (p=0.043). Neck complaints were more common (p=0.003) in patients with an major upper thoracic curve (42%) followed by thoracic curves (29%), thoracolumbar curves (23%), and lumbosacral curves (17%).

There was no statistically significant difference in BMI, gender distribution, or CCMI between patients who had neck complaints and those that did not. Curve magnitude, coronal and sagittal balance were unrelated to neck pain complaints. Binary logistic regression showed that a more proximal Upper End Vertebra was predictive of the presence of neck pain complaints in patients with adult spinal deformity (p=0.001).

Conclusion: The data suggests that an increased focus on the relationship between adult scoliosis and cervical spine pathology is warranted. It seems reasonable to presume that degenerative changes in the cervical spine may impact the clinical course of an adult spinal deformity, and visa versa.

© 2010 Lippincott Williams & Wilkins, Inc.