Adult Scoliosis: A Health Assessment Analysis by SF-36

STUDY DESIGN: A prospective self-assessment analysis of a consecutive series of adult patients diagnosed with adult scoliosis of adolescent onset or de novo degenerative scoliosis. PURPOSE: To analyze the impact that scoliosis has on patient health perceptions. SUMMARY OF BACKGROUND DATA: There exists little data studying the effect scoliosis has on an adult's self-perception of health. METHODS: Inclusion criteria were: age > or =18 years, Cobb angle greater than 10 degrees, degenerative or idiopathic deformity, no prior surgery (spine), and complete records. Each patient completed the standard Short Form-36 (SF-36) questionnaire. For each patient, radiographic and clinical data were evaluated. After all data were collected, the mean, standard deviation (SD), and true N values of the Cobb angle were calculated. This study population was then divided into two groups: patients with a Cobb angle greater than 10 degrees and patients with a Cobb angle greater than 20 degrees. Comparison of the SF-36 data for adult scoliosis patients with the United States general population, the United States general population ages 55-64, and patients with hypertension and low back pain was undertaken. RESULTS: The mean age for the patients in this study was 63 years of age; 22 patients were diagnosed as having adult scoliosis of adolescent onset and 27 patients had de novo degenerative scoliosis. The Cobb angle in this study group was found to be greater than 20 degrees in 41 patients; of these patients, 19 patients had a diagnosis of adult scoliosis of adolescent onset and 22 patients had a diagnosis of de novo degenerative scoliosis. Taken as a whole, the patients in this study averaged scores much lower than the norms for both the general U.S. population in all 8 categories and the U.S. population for ages 55 to 64 in 7 out of 8 categories of the SF-36 questionnaire. Additionally, patients with scoliosis also showed lower scores compared to that of the norms found of patients with comorbid conditions: back pain/sciatica with hypertension in seven of the eight categories: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. Of the radiographic parameters analyzed, loss of lumbar lordosis revealed a significant correlation with social function: P = 0.018; role emotional: P = 0.038; and overall general health: P = 0.05. The other radiographic parameters did not reveal statistically significant correlation to the calculated SF-36 scores. CONCLUSION: Our data clearly demonstrate the impact that adult scoliosis has on a patient's perception of health. The severity of this impact is strikingly apparent in the SF-36 scores when compared to benchmark data on patients with comorbid conditions such as back pain and hypertension. It is our conclusion that adult scoliosis is becoming a medical condition of significant impact, affecting the fastest growing section of our society to a previously unrecognized degree.