Vitamin D Deficiency and Surgical Outcome in Adolescent Idiopathic Scoliosis in Low Socioeconomic Status in Rural India
Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 8-13 | Ujjwal Kanti Debnat, Shweta Bhyri, Biplab Maji, Alaaeldin Ahmad, Shubhadip Chakraborty, Joydeep Das
DOI: https://doi.org/10.13107/jcorth.2025.v10i01.703
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2025; The Author(s).
Submitted Date: 13 Feb 2025, Review Date: 15 Mar 2025, Accepted Date: ?? Apr 2025 & Published Date: 30 Jun 2025
Author: Ujjwal Kanti Debnat [1], Shweta Bhyri [2], Biplab Maji [2], Alaaeldin Ahmad [2], Shubhadip Chakraborty [1], Joydeep Das [1]
[1] Department of Orthopaedics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
[2] Department of Paediatrics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
Address of Correspondence
Dr. Ujjwal K Debnath,
Consultant, Orthopaedics & Spine Surgeon, Professor Department of Orthopaedics, Jagannath Gupta Institute of Medical Sciences (JIMSH), Budge Budge, Kolkata, India
India.
E-mail: debs10uk@gmail.com
Abstract
Introduction: Patients with adolescent idiopathic scoliosis (AIS) have a higher prevalence of Vitamin D deficiency compared with healthy peers. Hypothesis: Vitamin D deficiency in AIS patients does not have a good functional outcome after posterior instrumented corrective spinal fusion.
Materials and Methods: A prospective consecutive study of 62 children who underwent surgery for AIS had pre-operative measurement of Vitamin D levels [serum 25-hydroxyvitamin D (ng/mL)]. Post-operative AIS patients were followed up for 2 years after surgery. Data on the history of back pain, socioeconomic status, curve magnitude, age, and gender were recorded. Patients were categorized based on Vitamin D level: deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). The correlation between Vitamin D levels and Scoliosis Research Society (SRS)-22 scores was analyzed using multivariable analysis and pair-wise comparisons using Tukey method.
Results: Sixty-two AIS patients (47 Females and 15 Males) were enrolled who underwent posterior instrumented spine fusion. The mean age at surgery was 15.24 ± 4.5 years. Major coronal curves had a mean of 68.08 ± 12° preoperatively and 12.19 ± 4.2° postoperatively. It was found that 35 (56.45%) of patients were Vitamin D deficient, 23 (37.09%) were insufficient, and 4 (6.45%) were sufficient. Although there was no correlation between Vitamin D level and pain, mental health, or satisfaction domains (P > 0.05), Vitamin D-deficient patients were found to be younger than 18 years of age (P < 0.001) and had lower SRS-22 function (P = 0.010), Self-image (P = 0.049), and total scores (P = 0.007).
Conclusion: AIS patients with Vitamin D deficiency (<20 ng/mL) are more likely to be younger at the time of surgery, and report lower function, self-image, and total SRS-22 scores postoperatively.
Keywords: Adolescent Idiopathic Scoliosis, Posterior Spinal Fusion, Vitamin D Deficiency
References
1. Holick MF. Vitamin D and bone health. J Nutr 1996;126:1159S-64.
2. Balioglu MB, Aydin C, Kargin D, Albayrak A, Atici Y, Tas SK, et al. Vitamin-D measurement in patients with adolescent idiopathic scoliosis. J Pediatr Orthop B 2017;26:48-52.
3. Lam B, Cheuk KY, Tam E, Man E, Lee W, Lee S, et al. Determinants of effective control of curve progression using calcium and Vitamin D supplementation in adolescent idiopathic scoliosis in-depth analysis of a randomized double-blinded placebo-controlled trial. J Child Orthop 2017;11:S147.
4. Radhakrishnan M, Nagaraja SB. Modified Kuppuswamy socioeconomic scale 2023: Stratification and updates. Int J Community Med Public Health 2023;10:4415-8.
5. Slattery C, Verma K. Classifications in brief: The lenke classification for adolescent idiopathic scoliosis. Clin Orthop Relat Res 2018;476:2271-6.
6. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of Vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30.
7. Bagó J, Pérez-Grueso FJ, Les E, Hernández P, Pellisé F. Minimal important differences of the SRS-22 patient questionnaire following surgical treatment of idiopathic scoliosis. Eur Spine J 2009;18:1898-904.
8. Wang WJ, Yeung HY, Chu WC, Tang NL, Lee KM, Qiu Y, et al. Top theories for the etiopathogenesis of adolescent idiopathic scoliosis. J Pediatr Orthop 2011;31:S14-27.
9. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 2013;7:3-9.
10. Estrada K, Styrkarsdottir U, Evangelou E, Hsu YH, Duncan EL, Ntzani EE, et al. Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture. Nat Genet 2012;44:491-501.
11. Medina-Gomez C, Kemp JP, Estrada K, Eriksson J, Liu J, Reppe S, et al. Meta-analysis of genome-wide scans for total body BMD in children and adults reveals allelic heterogeneity and age-specific effects at the WNT16 locus. PLoS Genet 2012;8:e1002718.
12. Lee WT, Cheung CS, Tse YK, Guo X, Qin L, Lam TP, et al. Association of osteopenia with curve severity in adolescent idiopathic scoliosis: A study of 919 girls. Osteoporos Int 2005;16:1924-32.
13. Hung VW, Qin L, Cheung CS, Lam TP, Ng BK, Tse YK, et al. Osteopenia: A new prognostic factor of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am 2005;87:2709-16.
14. Luo J, Pollintine P, Gomm E, Dolan P, Adams MA. Vertebral deformity arising from an accelerated “creep” mechanism. Eur Spine J 2012;21:1684-91.
15. Dickson RA, Stamper P, Sharp AM, Harker P. School screening for scoliosis: Cohort study of clinical course. Br Med J 1980;281:265-7.
16. Yawn BP, Yawn RA, Hodge D, Kurland M, Shaughnessy WJ, Ilstrup D, et al. A population-based study of school scoliosis screening. JAMA 1999;282:1427-32.
17. Nissinen M, Heliövaara M, Ylikoski M, Poussa M. Trunk asymmetry and screening for scoliosis: A longitudinal cohort study of pubertal schoolchildren. Acta Paediatr 1993;82:77-82.
18. Normand E, Franco A, Marcil V. Nutrition and physical activity level of adolescents with idiopathic scoliosis: A narrative review. Spine J 2020;20:785-99.
19. Binkley N, Ramamurthy R, Krueger D. Low Vitamin D status: Definition, prevalence, consequences, and correction. Endocrinol Metab Clin North Am 2010;39:287-301.
20. Mayes T, Anadio JM, Sturm PF. Prevalence of Vitamin D deficiency in pediatric patients with scoliosis preparing for spinal surgery. Spine Deform 2017;5:369-73.
21. Bolek-Berquist J, Elliott ME, Gangnon RE, Gemar D, Engelke J, Lawrence SJ, et al. Use of a questionnaire to assess Vitamin D status in young adults. Public Health Nutr 2009;12:236-43.
22. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of Vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 2004;158:531-7.
23. Zavatsky JM, Peters AJ, Nahvi FA, Bharucha NJ, Trobisch PD, Kean KE, et al. Disease severity and treatment in adolescent idiopathic scoliosis: The impact of race and economic status. Spine J 2015;15:939-43.
24. Klaas SJ, Kelly EH, Anderson CJ, Vogel LC. Depression and anxiety in adolescents with pediatric-onset spinal cord injury. Top Spinal Cord Inj Rehabil 2014;20:13-22.
25. Wong AY, Samartzis D, Cheung PW, Cheung JP. How common is back pain and what biopsychosocial factors are associated with back pain in patients with adolescent idiopathic scoliosis? Clin Orthop Relat Res 2019;477:676-86.
26. Lin T, Meng Y, Ji Z, Jiang H, Shao W, Gao R, et al. Extent of depression in juvenile and adolescent patients with idiopathic scoliosis during treatment with braces. World Neurosurg 2019;126:e27-32.
27. Chang WP, Lin Y, Huang HL, Lu HF, Wang ST, Chi YC, et al. Scoliosis and the subsequent risk of depression: A nationwide population-based cohort study in Taiwan. Spine (Phila Pa 1976) 2016;41:253-8.
28. Ravindra VM, Godzik J, Dailey AT, Schmidt MH, Bisson EF, Hood RS, et al. Vitamin D levels and 1-year fusion outcomes in elective spine surgery: A prospective observational study. Spine (Phila Pa 1976) 2015;40:1536-41.
29. Hawes M. Impact of spine surgery on signs and symptoms of spinal deformity. Pediatr Rehabil 2006;9:318-39.
30. Wenger DR, Mubarak SJ, Leach J. Managing complications of posterior spinal instrumentation and fusion. Clin Orthop Relat Res 1992;284:24-33.
31. Metzger M, Kanim L, Zhao L, Robinson ST, Delamarter RB. The relationship between Vitamin D status and successful spinal fusion. Spine J 2013;13:S53.
32. Kerezoudis P, Rinaldo L, Drazin D, Kallmes D, Krauss W, Hassoon A, et al. Association between Vitamin D deficiency and outcomes following spinal fusion surgery: A systematic review. World Neurosurg 2016;95:71-6.
| How to Cite this article: Debnat UK, Bhyri S, Maji B, Ahmad A, Chakraborty S, Das J. Vitamin D Deficiency and Surgical Outcome in Adolescent Idiopathic Scoliosis in Low Socioeconomic Status in Rural India. Journal of Clinical Orthopaedics January-June 2025;10(1):00-00. |
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