J Korean Soc Spine Surg.  2007 Mar;14(1):17-24. 10.4184/jkss.2007.14.1.17.

A Comparison of Bone Mineral Density between Adolescent Idiopathic Scoliosis and Neuromuscular Scoliosis

• Moon ES
• Moon SH
• Lee HM
• Park JO
• Shin DE
• Ha JW
• Jung M
• Kim HS

• KMID: 1527139
• DOI: http://doi.org/10.4184/jkss.2007.14.1.17

Abstract

STUDY DESIGN: A Cross-sectional study
OBJECTIVE
This study evaluated the degree of osteoporosis of adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS) and compared bone mineral density. LITERATURE REVIEW: In osteoporosis, bone mineral density was not as dense even in the outer layer, and the cortex was thinner than normal. A larger screw doss not enhance the screw stability and can break the thin cortex in osteoporotic vertebrae.
MATERIALS AND METHODS
This study reviewed the cases of consecutive patients with scoliosis, who underwent an osteoporosis examination before surgery between August 2004 and June 2006. The osteoporosis examination included DEXA in lumbar vertebrae and proximal femur. The mean osteoporotic degree of both femurs was recorded. The data was analyzed using the BMD(bone mineral density, g/cm(2)) and Z value of the BMD according to age, gender, and ethnicity.
RESULTS
The mean degree of the coronal deformity was 48.4 in AIS and 62.9 in NMS. A comparison of both groups revealed a significantly lower BMD and Z value of Femur, and BMD of the vertebra in the NMS patients (p<0.05). A comparison between AIS and non-ambulant NMS showed that all parameters were significantly lower in the non-ambulant NMS (p<0.05). Neither the BMD and Z value of the AIS nor the NMS were associated with the severity of the spinal deformity.
CONCLUSION
A lower BMD was measured in patients with non ambulant NMS than AIS. The degree of the osteoporosis, particularly of the non ambulant NMS patients need to be considered before undergoing surgery.

Keyword

Scoliosis; Osteoporosis

MeSH Terms

Adolescent*
Bone Density*
Congenital Abnormalities
Cross-Sectional Studies
Dioctyl Sulfosuccinic Acid
Femur
Humans
Lumbar Vertebrae
Osteoporosis
Scoliosis*
Spine
Dioctyl Sulfosuccinic Acid

Figure

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  Fig. 1. The DEXA of lumbar vertebra was taken after correcting the 2nd one as a neutral portion to decrease errors caused by rotational deformity in scoliosis.

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  Fig. 2. Forteen year old male patient with Duchenne muscular dystrophy. (A) The degree of coronal deformity was 77 and bone mineral density (z-score) was 0.465 g/cm2 (-3.95) in femur and 0.356 g/cm2 (-4.2) in vertebra. (B) Posterior correction and fusion were performed using pedicle and iliac screws and sublaminar cables with allo cancellous bone. (C) Sublaminar cabling (arrow) was performed to prevent the pullout of the upper thoracic screws.

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  Fig. 3. Twelve year old male patient with Duchenne muscular dystrophy. The degree of coronal deformity was 58 and the sagittal deformity was more severe than coronal one (A, B). At first, anterior release and fusion was performed for the correction of lumbar kyphosis, and then posterior correction and fusion was performed using instrumentation and allo cancellous bone. Sublaminar cabling was performed in the upper thoracic area (C, D).

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