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.

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