Prevalence and Significance of Vitamin D deficiency in Patients with Idiopathic Scoliosis Requiring Corrective Surgery

Abstract

Introduction Vitamin D deficiency may affect children in terms of growth disturbance, deformity and metabolic disease. The senior authors have felt significant difference in bone quality intra operatively and wondered if vitamin D status was relevant in this. The aim was to assess the prevalence of vitamin D deficiency in a cohort of patients undergoing scoliosis correction surgery for adolescent idiopathic scoliosis (AIS) and to assess if Vitamin D deficiency had any significance/correlation to the pre-operative cobb angle or pain scores. Material and Methods Any patient undergoing corrective surgery for AIS who had pre-operative Vitamin D sample taken. From January to December 2014 a total of 69 records were assessed yielding a cohort of 41 patients undergoing surgery for Adolescent Idiopathic Scoliosis (AIS) with a recorded pre-operative total 25-OH vitamin D level. Three tiers of Vitamin D level were assessed including normal > 50nmol/L, insufficiency < 50 but > 25nmol/L and deficiency < 25nmol/L as per local guidelines for Vitamin D deficiency in children. Patients' age, sex, pre-operative vitamin D levels, Cobb angles at time of surgery, pre-operative back pain scores were recorded. Results 41 Children with a recorded Vitamin D level pre-operatively were analyzed. There were 4 male and 37 females. The average age at surgery was 15 years,(range 12 – 17). Of the 41 patients 9 (22%) were Vitamin D Deficient (range 10–25), 14 (34%) were insufficient (range 29.3–49.8) and 18 (44%) were above the treatment level (range 54.8 – 139.1). The average pre-operative Cobb angle for the deficient patients was 68 (range 50–89) compared with 64 (range 48 – 85) for the insufficient patients and 62 (range 44–76) for the patients with normal Vitamin D levels. The pain scores for each of the 3 groups revealed that the patients in each group complained of a similar (moderate) amount of back and rest pain pre-operatively. Conclusion Vitamin D deficiency in children leads to reduced calcium absorption from the bowel and may lead to skeletal deformity and rickets. The effect on bone healing of Vitamin D deficiency may have an affect on the quality of spinal fusion required as part of the surgical treatment for AIS and it is not known whether those patients undergoing surgery have adequate levels. This study reveals that 56% of patients had Vitamin D levels requiring supplementation. Further work is being undertaken to evaluate pain values, fusion time and deformity correction in those children with insufficient or deficient levels of vitamin D.post-op complications and hospitalisation