Fewer spine degenerations among Southeast Asians than among Southern Chinese suggests populations from a warmer climate have inherently better spine health

Abstract

Background: Compared with older Caucasians, older Chinese have remarkably lower prevalence and lower severity of spine degenerative changes. There have been few studies on Southeast East populations. This study aims to compare radiographic spine degeneration features among older Hong Kong (HK) Chinese, older Thais, and older Indonesians.

Methods: This study included 195 Thai women (mean: 73.6 years), 202 Thai men (mean: 73.7 years), 227 Indonesian women (mean: 70.5 years), and 174 Indonesian men (mean: 70.2 years), as well as same number of gender- and age-matched HK Chinese. The recruitment plan was that the participants would represent the general older population of their respective communities. With spine radiograph, spine hyper-kyphosis, osteoarthritic wedging (OAw), acquired short vertebrae (SVa), general osteophyte formation, lumbar disc space narrowing, and lumbar spondylolisthesis were assessed.

Results: Compared with Southeast Asians (Thais and Indonesian data together), Chinese women and men had a higher prevalence of hyper-kyphosis (24.9% vs. 16.4%), OAw (2.4% vs. 0.9%), general osteophyte formation (15.3% vs. 10.5%), lumber disc space narrowing (27.6% vs. 20.3%), and lumbar spondylolisthesis (20.7% vs. 15.3%). The trends were also consistent for sub-group data analyses. An even lower prevalence was noted among Indonesian women and men than among Thais in general osteophyte formation (5.9% vs. 14.1%), lumbar disc space narrowing (18.3% vs. 24.1%), and lumbar spondylolisthesis (11.4% vs. 19.3%).

Conclusions: This study showed a lower prevalence of spine degeneration changes among older Thais and older Indonesians than among older Chinese. Indonesians, who inhabit an even warmer climate, show even fewer spine degeneration changes than Thais.

Keywords: Chinese; Southeast Asians; Spine; degeneration; vertebral deformities.

Figure 1

Examples of spine radiographic degenerative features. (A) A spine of normal morphology and physiological curve; (B) thoracolumbar junction hyper-kyphosis (arrow); (C) mid-thoracic spine osteoarthritic wedging (arrows) and hyper-kyphosis; (D) lower thoracic spine osteoarthritic wedging (arrows) and hyper-kyphosis; (E) a case with acquired short vertebrae and general osteophyte formation; (F) lumbar spondylolisthesis (grade 1 anterolisthesis, arrow); (G) lumber disc space narrowing (grade 1, arrow). (H) Lumber disc space narrowing (grade 2, arrows); (I) lumber disc space narrowing (grade 3, arrow).

Figure 2

One-to-one matched subgroup comparison of six spine degenerative features. Except acquired short vertebrae (short vertebrae), HK Chinese show an overall higher prevalence of spine degenerative changes than Thais or Indo, both for F and M. HK, Hong Kong; F, women; Thai, Thailand; Indo, Indonesians; M, men; OA wedging, osteoarthritic wedging.

Figure 3

One-to-one matched comparison of general osteophyte formation (A), lumber disc space narrowing (B), and lumbar spondylolisthesis (C) between Thais and Indo. Indonesians show a lower prevalence of these degenerative changes both for F and M. Thai, Thailand; F, women; Indo, Indonesians; M, men.

Figure 4

Lumber disc space narrowing (all grades) at four-disc levels. The highest prevalence is noted at L4/L5 level. A higher prevalence of lumber disc space narrowing is noted for HK Chinese than for Indo at the levels. However, the difference between HK Chinese and Thais is less notable. HK, Hong Kong; F, women; Thai, Thailand; Indo, Indonesians; M, men.

Figure 5

Lumbar spondylolisthesis (both antero- and retro-listhesis) at five-disc levels. The highest prevalence is at L4/L5 level. A higher prevalence of lumber spondylolisthesis narrowing is noted for HK Chinese than for Indo, both for F and M. However, the difference between HK Chinese and Thais is minimal. HK, Hong Kong; F, women; Thai, Thailand; Indo, Indonesians; M, men.