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Thread: Progrression of 35-50 Degree Curves with 20 Year Follow-Up

  1. #1
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    Progrression of 35-50 Degree Curves with 20 Year Follow-Up

    From the SRS meeting:

    74. Minimum 20-Year Radiographic Outcomes for Treatment of Adolescent
    Idiopathic Scoliosis: Preliminary Results from a Novel Cohort of US Patients
    A. Noelle Larson, MD; David W. Polly, MD; William J. Shaughnessy, MD; Michael
    J. Yaszemski, MD, PhD
    USA

    Summary: AIS patients with 35-50 curves treated nonoperatively in childhood
    had progression in adulthood at a slow rate (mean 0.5 degree per year for
    thoracic curves). However, some individuals had rapid progression and others had
    no progression. Further work is required to determine why this occurs.

    Introduction: There is limited recent data regarding the long-term outcomes
    of scoliosis treatment. This study evaluates the minimum 20-year outcomes
    following treatment of adolescent idiopathic scoliosis with bracing, surgery, or
    observation in a novel cohort of US patients.

    Methods: All patients had radiographs from adolescence at skeletal maturity
    (Risser 4 or 5) and were contacted for current radiographs, pulmonary function
    tests, and physical exam. Patients had at least a 35 idiopathic scoliosis
    curve magnitude during adolescence. Childhood treatment included bracing/
    observation (19) and surgery (12, either Harrington or CD instrumentation).
    Results: Thirty-one patients had radiographs/physical exam at a minimum of
    20-years following treatment. Mean time to follow-up was 28.1 years (range,
    20-36). Mean age at childhood radiographs was 16.4 (range, 14 - 20). Mean
    age at follow-up was 44.1 years (range, 36-54). Of the 19 nonoperative
    patients, only 3 did not progress (Figure). For the remaining 16 patients,
    thoracic curves progressed a mean of 0.54 per year (range, 0.2 - 1.3), and
    lumbar curves progressed 0.37 (range, 0.2-0.9). Larger curves more frequently
    progressed (Rsquare 0.61, 0.49). Three patients in the nonoperative group
    underwent spine surgery in adulthood for lumbar discectomy (1), anterior
    cervical fusion (1), and lumbar fusion (1) below the level of the deformity. Of
    the 12 operative patients, 3 (25%) had additional procedures in adulthood,
    including implant removal (2) and distal extension of the fusion (1). Despite
    fusion, 8/12 surgical patients had mild curve progression, at a rate of 0.3 per
    year.

    Conclusion: Idiopathic scoliosis curves between 35-50 continue to progress
    during adulthood, but this varies by individual. Thoracic curves progress more
    quickly than lumbar. Elucidation of the factors which govern progression in
    adulthood may help guide childhood treatment recommendations.
    Curve progression for each patient. The solid line represents no change. The
    broken lines indicate +/- 5 degrees.

    SRS 74.jpg
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
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  2. #2
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    i am surprised that thoracic curves progress faster than
    lumbar curves...
    to me, the lumbar area seems to have more stressors and
    less support...
    that is just a subjective observation....

    is there any known reason for different rate of progression
    of thoracic vs. lumbar curves....????

    jess

  3. #3
    Join Date
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    Location
    Northern California
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    I'm guessing, but I bet if they look at the same patients again in another 20 years, there will be a big switch in those numbers.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  4. #4
    Join Date
    Mar 2010
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    2,755
    Jess,
    Just a guess, but since the thoracic vertebrae are less flexible, maybe the flexibility of the lumbar keeps it straighter. It's able to move around, whereas the thoracic has no means of exercise other than breathing and very little flexibility as compared to the lumbar.

    In short, maybe flexibility is a good thing!
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

  5. #5
    Join Date
    May 2011
    Posts
    76
    Makes me glad we did the surgery at 15 yrs for a 60 degree curve. At 35 years old it would potentially have been closer to 70-80 degrees.

  6. #6
    Join Date
    Mar 2010
    Posts
    2,755
    My original doctors predicted when I was 16 years old that I would "need" surgery in my early to mid 40's for a curve >40o.
    Although, it is official that I did reach over 40o and I was in my early 40's when my surgeon here diagnosed me as such, Dr. Perra at TCSP diagnosed me at 41o curve at the age of 29. His measurements now would probably put me over 50o as he measures curves less conservatively while other doctors measure curves more conservatively. Curve measurements aren't an exact science. Degrees of error are in reality degrees of subjectivity. My doctors at 16 were more conservative than the chiropractor that originally measured me at 39o. The ones at Phoenix Children's Hospital were measuring at 37o both standing and lying down (I remember that now. I got both each time. Maybe the concussion brought back some long term memory while it shot other memories to pieces!?) So according to them, they were spot on! Quite intriguing to me, really.

    But that's a super stiff curve is you ask me!
    Last edited by rohrer01; 09-26-2014 at 04:22 AM.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

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