The Hereditary Nature of Adolescent Spinal Deformities

A Study of Over 600,000 Adolescents

Yair Zloof, MD; Ran Ankory, MD; Amit Elbaz Braun, MD; Maya Braun, MSc; Shlomi Abuhasira, MD, MPH; Naama Schwartz, PhD; Dotan Yaari, MD; Elon Glassberg, MD; Amir Shlaifer, MD

Disclosures

Spine. 2022;47(12):841-846. 

In This Article

Abstract and Introduction

Abstract

Study Design: A cross-sectional study.

Objective: We designed this study to investigate the risk for spinal deformity among individuals whose parents had a spinal deformity.

Summary of Background Data: Adolescent idiopathic scoliosis and Scheuermann kyphosis (SK) are common adolescent spinal deformities (ASD) with a significant impact on public health. Timely treatment with bracing is effective in halting or slowing the progression of these deformities. However, screening healthy adolescents for spinal deformities remains debatable. While the leading medical organizations endorse contradictory positions regarding the screening of the general population, there is a consensus that screening of targeted population should be considered. Due to their genetic predisposition, adolescents whose parents suffer from a spinal deformity may be candidates for targeted screening.

Methods: We conducted a nationwide, population-based study of 611,689 Israeli adolescents, aged 16 to 19 years old, who were screened for spinal deformities between the years 2000 and 2019. The data for this study were derived from a central database containing medical records of all adolescents who were examined preliminary to mandatory military service. In our study, ASD were strictly defined by plain x-ray.

Results: Compared with adolescents of whose parents did not have a spinal deformity, the odds ratios (OR) for ASD among adolescents whose father, mother, or both parents had spinal deformity were 1.46, 1.74, and 2.58, respectively. These ratios were consistent in multivariate models.

Conclusion: We have found a considerable increased risk for adolescent spinal deformities among adolescents whose parents suffered from spinal deformities. We believe that our findings should serve the leading medical organizations when considering the screening of targeted populations.

Level of Evidence: 4

Introduction

Adolescent spinal deformity (ASD) is an idiopathic abnormal alignment or curve of the vertebral column, that develops in otherwise healthy children and adolescents.[1,2] Children and adolescents diagnosed with spinal deformities may suffer from back pain, psychological concerns, and reduced health related quality of life. Pulmonary and neurological complications can occur in severe cases.[3–5]

Adolescent idiopathic scoliosis (AIS) and Scheuermann kyphosis (SK) are the two most common spinal deformities, and combined together comprise the majority of ASD. The prevalence of AIS and SK is 1% to 3% and 1% to 8% respectively.[2,6–8] In 20% to 30% of patients, AIS and SK occur simultaneously.[9] The etiology behind these deformities remains unclear.[10–13] Currently, based on various family and twin studies, ASD is considered a multifactorial disease with a significant genetic predisposition.[6,7,14–16]

Most of the adolescent spinal deformities are of mild severity and do not require any medical intervention. Moderate to severe deformities are widely treated with bracing and physiotherapy, while surgery is performed only in the minority of severe cases.[17–24] Importantly, timely treatment with bracing is effective in halting or slowing progression of spinal deformities in adolescents.[18,22] However, routine screening of healthy adolescents for spinal deformity remains controversial. While the leading medical organizations endorse contradictory positions regarding the screening of the general population, there is consensus that screening of targeted population should be further investigated.[25,26]

Previous family studies that attempted to estimate the increased risk for spinal deformity among individuals whom their parents had suffered from the condition were limited by sample size and accordingly yielded inconsistent estimations.[7,8,15,16,27–29]

To the best of our knowledge, our study is the largest to investigate the hereditary nature of spinal deformities. We believe that our study adds valuable information that needs to be addressed when considering the screening of predisposed populations.

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