While technical outcomes of surgery are well known and show obvious benefits for those with significant deformity, long-term health related outcomes have yet to be precisely documented. The lack of quality, long-term studies of sufficient size hampers our understanding of the mortality and morbidity rates for patients with congenital and idiopathic scoliosis, with and without treatment. Fifty years of follow-up studies of children and adolescents with untreated scoliosis have shown conflicting results, with some studies indicating a higher risk of mortality and respiratory compromise.1,2
Another study shows compromise only in patients with early reduced lung function and a large curvature.3 Yet another study has shown no differences in untreated childhood scoliosis and a control group.4 Several articles from the 1960s and one recent article report that low back pain does not occur more frequently in untreated scoliosis patients than in the general population4,5,6 unless the curvature is greater than 40°.7,8 It has also been shown that persons treated with surgery rather than bracing for adolescent idiopathic scoliosis have less pain at 10- to 20-year follow-up, although function remains similar.9,10 The cosmetic/self-image aspect of scoliosis is obvious and important, and often a major factor affecting the lives of individuals with this condition.
- 1. Goldberg CJ, Gillic I, Connaughton O, et al: Respiratory function and cosmesis at maturity in infantile-onset scoliosis. Spine 2003;28:2397-2406.
- 2. Pehrsson K, Larsson S, Oden A, Nachemson A: Long-term follow-up of patients with untreated scoliosis: A study of mortality, causes of death, and symptoms. Spine 1992;17:1091-1096.
- 3. Pehrsson K, Bake B, Larsson S, Nachemson A: Lung function in adult idiopathic scoliosis: A 20-year follow-up. Thorax 1991;46:474-478.
- 4. a. b. Weinstein SL, Dolan LA, Spratt KF, et al: Health and function of patients with untreated idiopathic scoliosis: A 50-year natural history study. JAMA 2003;289:559-567.
- 5. Nachemson A: A long-term follow-up study of non-treated scoliosis. Acta Orthop Scand 1968;39:466-476.
- 6. Nilsonne U, Lundgren KD: Long-term prognosis in idiopathic scoliosis. Acta Orthop Scand 1968;39:456-465.
- 7. Kostuik JP, Bentivoglio J: The incidence of low-back pain in adult scoliosis. Spine 1981;6:268-273.
- 8. Haefeli M, Elfering A, Kilian R, et al: Nonoperative treatment for adolescent idiopathic scoliosis: a 10- to 60-year follow-up with special reference to health-related quality of life. Spine 2006;31:355-366.
- 9. Andersen MO, Christensen SB, Thomsen K: Outcome at 10 years treatment for adolescent idiopathic scoliosis. Spine 2006;31:350-354.
- 10. Danielsson AJ, Romberg K, Nachemson AL: Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for adolescent idiopathic scoliosis: A case-control study. Spine 2006;31:275-283.