Scoliosis in Adults Aged 50 Years and Older: Prevalence, Patterns, Associated Factors, and Evidence Gaps with Special Emphasis on Enugu Metropolis, Nigeria

Abstract

Scoliosis identified in later adulthood is increasingly recognised as an age-related spinal health problem, but its epidemiology remains difficult to quantify because adult scoliosis combines different aetiologies and because prevalence estimates are highly sensitive to sampling and imaging methods. This critical narrative review synthesises evidence on the prevalence, radiographic patterns, associated factors, natural history, and clinical relevance of scoliosis in adults aged 50 years and older, with particular attention to the evidence needed for Enugu Metropolis, Nigeria. Literature published from 1 January 1980 to 8 July 2026 was considered, with emphasis on population-based and community-oriented imaging studies, longitudinal cohorts, systematic reviews, and studies that clarify age, sex, bone health, degenerative change, muscle status, alignment, and symptoms. Reported prevalence varies markedly across studies, from single-digit estimates in broad adult samples to more than one-third in several elderly cohorts, while a small volunteer study reported a substantially higher estimate. This dispersion reflects genuine age effects but also differences in case definitions, age structure, recruitment, curve ascertainment, prior-scoliosis exclusion, and imaging modality. Age is the most consistent associated factor. Female predominance is supported in several datasets and a meta-analysis but is not universal. Evidence linking osteoporosis, body mass index, and sarcopenia to scoliosis remains inconsistent or largely cross-sectional. Longitudinal studies more strongly implicate asymmetric disc degeneration, vertebral rotation, lateral translation, and related segmental instability in de novo curve development or progression. Cobb angle alone incompletely captures clinical impact; sagittal imbalance, loss of lordosis, lateral listhesis, stenosis, and neural compression often better explain pain and disability. No verified population-based prevalence study specifically addressing adults aged 50 years and older in Enugu Metropolis was identified. The principal regional priority is therefore a representative, standardised radiographic epidemiological study that separates prevalence from clinic-based case frequency and couples coronal curvature with sagittal alignment, degenerative features, symptoms, function, and relevant exposures.