Health and Function of Patients With Untreated Idiopathic Scoliosis

Abstract

Context Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. Objective To present the outcomes related to health and function in untreated patients with LIS. Design, Setting, and Patients Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age-and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). Main Outcome Measures Mortality, back pain, pulmonary symptoms, general function, depression, and body image. Results The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80°and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P = .003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. Conclusions Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment

“…In our study, patients scored around four points on a five-point scale in the self-image/appearance domain, which implies that these patients were satisfied. Weinstein et al [21] concluded in their study that untreated AIS patients had cosmetic concerns. Although different measures were used, it seems that treated patients are more satisfied with selfimage than untreated patients.…”

“…Some information is available on long-term follow-up in AIS, but study results are not unanimous. Weinstein et al [21] concluded in a 50-year natural history study of untreated patients with late onset idiopathic scoliosis (LIS) that untreated LIS causes little physical impairment other than back pain and cosmetic concerns, and causes no increase in clinical depression compared to controls. Ascani et al [1] on the other hand, found no increased incidence of pain, but found real psychological disturbances in 19% of untreated AIS patients.…”

Natural history of adolescent idiopathic scoliosis: A tool for guidance in decision of surgery of curves above 50°

“…The third study group has been followed during life with the first follow-up published by Colles et al in 1969 [5] followed by a paper in 1981 [6] and the latest follow-up with a mean 51-year (44-61) follow-up [7]. Although a number of patients have been lost during follow-up, the studies of this patient group yields invaluable information, being the longest published follow-up of natural history of patients with AIS alone.…”

Brace Management in Adolescent Idiopathic Scoliosis

“…Long-term follow up of patients with idiopathic scoliosis has demonstrated more thoracic and lumbar back pain and degenerative disc disease [8,54]. Danielsson et al [8] followed 127 patients 22 years after brace treatment and found degenerative lumbar disc changes were more common than in control subjects.…”

“…This definition provides a starting point for treatment decisions in the growing spine. Left untreated in the growing child, numerous studies have demonstrated the negative long-term prognosis a progressive curve fosters into adulthood, including back pain, pulmonary compromise, cor pulmonale, psychosocial effects, and even death [8,9,43,[54][55][56]. Curve progression is the most important factor in the natural history of idiopathic scoliosis.…”