Prevalence, Patterns and

Associated factors of Scoliosis

among 50yr. and Older Adults in
Enugu Metropolis.
By
Chukwu Chidera Victoria.
24/05/2023.
Table of contents

CHAPTER ONE: INTRODUCTION

Background of study
Types of Scoliosis
Patterns of scoliosis
Objective of the study

CHAPTER TWO: LITERATURE REVIEW

Signs and Symptoms
Risk factors
Complications
Empirical review.
CHAPTER THREE: MATERIALS AND METHOD
Research population
Inclusion Criteria
Exclusion Criteria
Sample Size
Research Instrument
Procedure of Data Collection
Procedure of Data Analysis
CHAPTER FOUR: RESULT AND DISCUSSION
Demographic
Objective analysis.
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS

Conclusion
Recommendations
Chapter 1 : INTRODUCTION.
The increase in morbidity rate and mobility dependence among
adults and older adults has been widely associated with conditions
that affects the vertebra. And most times the major complain is
perceived as back pain, but diagnostically it can either be spondylitis,
spondylolisthesis, spondylosis, spinal stenosis, scoliosis or other
spinal condition.Older adults have limited regenerative ability and
are more prone to most chronic diseases and conditions like
scoliosis, hence reducing their quality of life.
This study reviewed related litrature on prevalence of scoliosis, it
patterns and association between scoliosis and participants
characteristics.
This study also reviewed literature on predominant degrees of lateral
spinal shift found among Older Adults.
Background of Study.

In upright position, the vertebral column displays four

curves. The cervical lordotic convex curve extends from
the occiput to the second thoracic vertebrae. The thoracic
kyphotic concave curve which extends from second
thoracic vertebra to the twelfth thoracic vertebra. The
concavity of the thoracic vertebrae is due to greater depth
of posterior parts of the vertebral bodies in the thoracic
region. The lumbar lordotic convex curve extends from
first lumbar vertebrae to the lumbosacral junction. Sacral
kyphotic concave curve extended from lumbosacral
junction to the coccyx.
According to WHO, scoliosis is defined as the lateral
shift of the spine which is more than 10 degrees. The
shift in the spine is often accompanied by vertebral
rotation in the transverse plane and hypokyphosis in
the sagittal plane.

Scoliotic curvature can be classified based on the

types and patterns . Based on types scoliosis can be
functional or structural.
Functional scoliosis results from a temporary cause and
only involves a side to side curvature of the spine
without spinal rotation.
• Structural scoliosis can either is idiopathic or as a
result of congenital conditions like cerebral palsy or
muscular dystrophy .It involves spinal rotation in
addition to side to side curvature of the spinal
• Furthermore, based on patterns, scoliosis can be
classified as thoracic scoliosis, lumbar scoliosis,
thoracolumbar scoliosis and combined scoliosis.
The prevalence of scoliosis in older adults has been
proposed to increase proportionately with the
continuous increase in median age of human
population. This projection is one of the propelling
forces behind this study.Several prevalence studies
on scoliosis has been dedicated to the diagnosis,
classification and treatment of scoliosis in children
and adolescent(Biot etal 1982; Carter etal ,
Francis,et. al). But limited information is available on
the associated factor of scoliosis among Older Adults.
Hence the aim to determine the prevalence, patterns
and associated factors of scoliosis among 50yrs and
older adults in Enugu Metropolis.
Some of the associated factors considered for this
study include demographic data, history of spinal
deformity/trauma, cause or perception of scoliosis,
previous or current treatment and knowledge of
physiotherapy management of scoliosis.
Objective of the Study.
1. To determine the prevalence of scoliosis among older adults in
Enugu metropolis.
2. To ascertain the common presentation of scoliosis among the older
adults in Enugu metropolis
3. To determine the factors associated with scoliosis among older
adults in Enugu metropolis.
4. To investigate the common interventions experienced by older
adults living with scoliosis in Enugu metropolis.
5.To determine the common range of lateral spinal shift among older
adults in Enugu metropolis.
 Chapter 2 : Literature Review

The adult degenerative scoliosis could be developed

as a result of degeneration of the disc, osteoporosis
and vertebral body compression fracture (Herkowitz
& Kurz, 1991). It may not be as a result of the
progression of adolescent idiopathic scoliosis.
However, some adolescent idiopathic scoliosis can
continue its curve progression throughout adulthood.
Signs and Symptoms
may include:
1. Uneven shoulders.
2. One shoulder blade that appears more prominent than the
other.
3. Uneven waist.
4. One hip higher than the other.
5. One side of the rib cage jutting forward.
6.A prominence on one side of the back when bending forward.
7. Reduction in height due to the curvature.
Risk factors
Some risk factors that can predispose an individual to scoliosis.
1. Increase BMI
2. Increase age
3. Sex
4. Low bone mineral density.
5. Bad posture
6. Family history.
7. Birth defects affecting the development of the bones of the spine.
8. Certain neuromuscular conditions, such as cerebral palsy or
muscular dystrophy.
Complications of scoliosis.

1. Difficulty in breathing : In severe scoliosis, the rib cage

may press again the lungs, make it's difficult for breathing
and lung expansion.
2. Back pain: scoliosis usually presents with chronic back
pain.
3. Low self esteem: Individuals with scoliosis become
overly conscious of their appearance, due the bodily
changes the conditions caused . And this can lead to
reduced self worth.
Emperical review.
Study on thoracic scoliosis prevalence in patients 50yrs or older and its
relationship with age, sex and thoracic kyphosis by Urrutia etal (2014).The
result of the study shows that the prevalence of thoracic scoliosis was
24.2% .Females exhibited a higher prevalence of scoliosis then males. The
study also shows that Age and sex were independent predictors . And bone
mineral density is a dependent predictor of Scoliosis.
Khalad etal (2011) studied Scoliosis in Adults aged forty years and
older,Prevalence and relationship to age, race and gender.The Results shows
Prevalence rates differed among races (e.g., 11.1% for whites and 6.5% for
African Americans) iand African Americans were more likely to have mild
curves (94.3%) than other race.
Chapter 3:Material and method
The target population for this study (older adults)
was selected using a purposive sampling
technique.The older adults that are present during
the data collection process and meet the inclusion
criteria was invited to participate in the study .The
aims of the study was explained to them (the
participants), and they were enrolled in the study if
they provided consent.
Inclusion Criteria
50 year or older adults
50 years or older adults that is willing to participate in the
study.
Exclusion Criteria
50 years or older adults that have any of musculoskeletal
impairment.
Older adults that have undergone any spinal reparative
surgery or currently using any corrective brace.
Older adults that are bed ridden
The date was collected using a self developed
proforma and a digital scoliometre (Orthopedic
system ICN make) was used to measure the degree
of deviation in the spine, scoliosis was diagnosed
from ≥10degrees scoliometer measurement.
Procedure.
The area was screened and the participants was
asked removed their upper body clothing and stand
erect.
They were further asked to bend forward (adams
forward bend test), the spine was carefully observed
by the researcher to determine the pattern and type
of scoliosis present. Using 7th cervical vertebrae to
the 2nd sacral vertebrae as land mark, the
scoliometer was placed on the participant’s spine.
And it was further slid through the spine to
determine the degrees of lateral shift present and
data was recorded.
Method of data analysis:
The data was analyzed using SPSS for windows
version 23.0.Prevalence of scoliosis, its pattern and
the participants’ characteristics were presented
descriptively in tabular form by using percentage and
frequencies. The chi-square test was used to
determine the association between presence of
scoliosis and personal / clinical characteristics of the
participants.
Chapter 4:Results and Discussion
A total of 157 older adults participated in this study.
Majority of the participants is between the age range
of 50-69years 113(72%) and 70-90 years 44(28%).
They were mostly female117 (74.5%) and male
40(25.5%). Majority of the participant’s previous or
current occupation was trading 61(38.9%), followed
by manual work 43(27.4%) and 22 office workers.
Majority of the participant overweight 62(39.5%),
followed by normal weight 41(26.1%) and the least
was underweight 2(1.3%).
Objective One
This objective sought to determine the prevalence of
scoliosis among the older adults in Enugu metropolis.
(≥10measurement on the scoliometer)
The study revealed that majority of the participants
106(67.5%) presented with scoliosis while 51(32.5%)
did not present the condition. Thus, the prevalence
of scoliosis among older adults in Enugu metropolis is
67.5%.
Objective Two
This objective sought to ascertain the common
pattern (presentation) of scoliosis among the older
adults in Enugu Metropolis.
majority of the participants presents with lumbar
43(27.4%), followed by thoracic 37(23.4%) patterns
of scoliosis .The least were thoracolumbar 13(8.3%)
and combined 13(8.3%) patterns of scoliosis.
 Objective Three
Sought to determine Association of presence of scoliosis
with Age, Gender, BMI, Occupation, and other
participants’ clinical characteristics.
Results revealed that there is significant association
between presence of scoliosis and history of spinal
deformity or previous spinal trauma (p=0.013).
Significant association was also seen between presence
of scoliosis, BMI (p=0.01)and previous or current
occupation (p=0.002).
However, there is no significant association between
presence of scoliosis ,age (p=0.62), and gender
(p=0.11). There is also no significant association
between presence of scoliosis and cause or
perception of scoliosis (p=0.478). It was also revealed
that most participants had no knowledge of
physiotherapy management of scoliosis.
Objective four.
To determine common intervention experienced by
older adults living with scoliosis. The results shows that
majority of the participants did not experience any
intervention 79(63.1%) followed by the use of drugs 25
(29.3%), and massage therapy (1.3%).
Objective five.
The results shows that, the most common degree of
lateral shift is 10 - 19degrees ,73(62.4%) followed by 20
- 29degrees,31(20.4%) and the least was 30 and above
2(1.3%).
Chapter 5: Conclusion and
Recommendations
On the basis of this study outcome, the following
conclusions were made; the prevalence of scoliosis
among older adults in Enugu metropolis is 67.5%,
thus the prevalence is in agreement with other
works. The most prevalent pattern of scoliosis among
older adults is lumbar pattern, most common type
being the functional type of scoliosis and the most
common intervention experienced is the use of
NSAIDs followed by the use massage therapy.
The most common degrees of lateral shift are 10-
19degrees. The results also revealed that the
presence of scoliosis had a significant association
with history of spinal deformity or trauma, Increase
in BMI and previous or current occupation.
Recommendation
This study findings led to the following
recommendation; adequate attention is needed for
proper and detailed examination of older adults
spine.
Proper documentation should be implemented by
health care professionals on factors associated with
scoliosis among older adults and for future research,
measurements should be taken using the Cobb's
angle . Attention should be give to female overweight
older adults who are within 50-69 years age category.
There is need for counselling on back care and there
is also need for adequate awareness on
physiotherapy management of scoliosis.
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Thank you .