Pappou Ioannis P, Girardi Federico P, Sandhu Harvinder S, Parvataneni Hari K, Cammisa Frank P, Schneider Robert, Frelinghuysen Peter, Lane Joseph M
Hospital for Special Surgery, New York, NY 10021, USA.
Spine (Phila Pa 1976). 2006 Jun 15;31(14):1614-20. doi: 10.1097/01.brs.0000222030.32171.5f.
Retrospective study.
The purposes of this study were: 1) to investigate the validity of bone mineral density measurements with DEXA in patients with adult lumbar scoliosis and 2) to investigate the association between osteoporosis and adult lumbar scoliosis.
Osteoporosis and lumbar degenerative scoliosis are phenomena encountered with increased frequency in aging, often concurrently. It has been suggested that scoliosis predisposes to osteoporosis, but degenerative scoliosis could falsely elevate spinal bone mineral density measurements.
The feasibility of measuring Cobb's angle in DEXA scans was established in 48 surgical candidates with standing anteroposterior lumbar radiographs and supine DEXA scans. Charts and radiographs of 454 consecutive adult patients evaluated at an osteoporosis center were reviewed thereafter. The association between age, lumbar curve, and various bone density measurements was investigated. Bone density measurements between nonscoliotic and scoliotic patients with and without a history of adolescent scoliosis were compared.
Cobb's angle on DEXA scan was measured with an error of 4 degrees and correlated highly with the plain lumbar radiographs. The prevalence of scoliosis was 9.47% in this cohort of patients. Advancing age was associated with an increase in osteoporosis in both scoliotic and nonscoliotic patients. Scoliotic patients demonstrated increased spinal bone mineral density (BMD) measurements compared with nonscoliotic patients, resulting in discrepancies between hip and spine BMD values. This discrepancy correlated with aging and curve magnitude (up to 30% for curves of 43 degrees ). Scoliotic patients demonstrated significantly lower hip BMD values than nonscoliotic. Curve magnitude did not correlate with severity of osteoporosis.
Cobb's angle measurements on DEXA scans are reliable and comparable to conventional radiographs. Spinal BMD values are less valuable for monitoring osteoporosis than hip values in scoliotic patients; an increasing discrepancy with age was noted. Scoliotic patients exhibited discordantly high spinal BMD values, despite significant hip osteoporosis. The discrepancy correlated with aging and curve magnitude. Scoliosis was common among the osteoporotic population (9.47%). Lumbar scoliosis is a useful clinical marker for osteoporosis, irrespective of scoliosis history and magnitude. Viable alternatives for osteoporosis evaluation of adult patients with lumbar scoliosis are hip DEXA values, in conjunction with other BMD measurements.
回顾性研究。
本研究的目的为：1）调查双能X线吸收法（DEXA）测量成年腰椎侧弯患者骨密度的有效性，以及2）调查骨质疏松症与成年腰椎侧弯之间的关联。
骨质疏松症和腰椎退行性侧弯在老龄化人群中愈发常见，且常同时出现。有观点认为，侧弯易引发骨质疏松症，但退行性侧弯可能会使脊柱骨密度测量值出现假性升高。
对48例需接受手术的患者进行站立位腰椎前后位X线片和仰卧位DEXA扫描，以此确定在DEXA扫描中测量Cobb角的可行性。随后，回顾了在一个骨质疏松症中心接受评估的454例成年患者的病历和X线片。研究了年龄、腰椎曲度与各种骨密度测量值之间的关联。比较了有或无青少年侧弯病史的非侧弯患者与侧弯患者之间的骨密度测量值。
DEXA扫描测得的Cobb角误差为4度，与腰椎X线平片高度相关。该队列患者中侧弯的患病率为9.47%。年龄增长与侧弯和非侧弯患者的骨质疏松症增加均相关。与非侧弯患者相比，侧弯患者的脊柱骨密度（BMD）测量值升高，导致髋部和脊柱BMD值出现差异。这种差异与年龄和曲度大小相关（43度曲度时差异高达30%）。侧弯患者的髋部BMD值显著低于非侧弯患者。曲度大小与骨质疏松症的严重程度无关。
DEXA扫描测量的Cobb角可靠，与传统X线片相当。在侧弯患者中，脊柱BMD值对于监测骨质疏松症的价值低于髋部BMD值；且随着年龄增长差异增大。尽管髋部存在明显骨质疏松症，但侧弯患者的脊柱BMD值却异常升高。这种差异与年龄和曲度大小相关。侧弯在骨质疏松症人群中很常见（9.47%）。无论侧弯病史和程度如何，腰椎侧弯都是骨质疏松症的一个有用临床指标。对于成年腰椎侧弯患者，可行的骨质疏松症评估替代方法是髋部DEXA值，以及其他BMD测量值。
