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Thread: Treasure trove of good information on long-term outlook for scoliosis patients

  1. #1
    Join Date
    Aug 2009

    Treasure trove of good information on long-term outlook for scoliosis patients

    This is my favorite recent review of long-term outcomes for scoliosis patients - Marc Asher, 2006 -

    Not only is it a clearly written, well-organized summary of just about any question you might want to know, it has a great references section where you can dig through the detailed information.

    The bad news, as in all of these kinds of reviews, is that there is still very little information on newer hardware. Most of the surgical studies they quote are of Harrington Rods. The bracing information and information on untreated patients, though, should be relatively up-to-date.

    I'll post the summary but, really, the whole article is worth reading:

    Knowledge of the natural history of adolescent idiopathic scoliosis has expanded greatly in the last two decades. It has become clear that only about one in ten curves progresses to the point that treatment with bracing is warranted, and only one in 25, or 0.1%, to the point that surgery is warranted.

    Compared to controls untreated adolescent idiopathic scoliosis does not result in an increased mortality rate. However, it may on rare occasion progress to the point of causing death by cor pulmonale. The rate of dyspnea is slightly increased and is associated with thoracic curves of greater than 80. Most patients with untreated adolescent idiopathic scoliosis function at or near normal levels, even though pain is more prevalent. Self image is often slightly diminished. Mental health is usually normal.

    Bracing appears to prevent about 20% to 40% of appropriately braced curves from progressing 6 or more.

    Surgery, consisting of instrumentation and arthrodesis has virtually eliminated large thoracic curves. Although most patients are satisfied with their results, follow-up at 20+ years shows significant, clinically relevant decrease in function and increase in pain compared to controls. Re-operation is required in 6 to 29%. And, a very few have pain management problems.

    Even though the natural history and long term treatment effects on adolescent idiopathic scoliosis have become a lot clearer, there are still many unknowns. Non-operative treatment effectiveness is limited and needs to be improved. Selection of adolescent patients for surgery is usually straightforward for major thoracic curves, but is much more problematic for double, lumbar and even thoracolumbar curves. This is because of the low level of instrumentation and arthrodesis required, and the resulting stress concentration on the remaining mobile lumbar motion segments. While ten to twenty-five years is a long term follow-up after treatment, the patients are still relatively young, 30 to 40 years of age. Longer periods of follow-up are needed as they become increasing difficult to accomplish."

    [Edit: I'm highlighting one line about surgery, because, although I've seen papers talking about problems developing below fusions that go into the lumbar spine, I don't think I've actually heard someone say that surgeons should exercise caution in "selecting adolescent patients for surgery." Here's the detail from the review on that caution

    "The principle indication for surgery during adolescence is a thoracic curve that will reach 50 or more by skeletal maturity. The other curve patterns are more problematic because of the risk of low back pathology and pain after fusion into the low lumbar spine. However, thoracolumbar curves that will reach 50 to 60 at maturity may also be considered for surgery because of their association with a marked degree of deformity and vertebral translatory shift [24]. The indication for surgery, based on curve size, for double and lumbar curves cannot currently be stated with precision, but conservatism seems appropriate."]
    Last edited by hdugger; 05-20-2013 at 11:02 PM.

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