24. Untreated adolescent idiopathic scoliosis in adulthood: how often do these patients require surgery?

Abstract

BACKGROUND CONTEXT Weinstein and Ponsetti demonstrated that despite increased pain, adults with previously unoperated adolescent idiopathic scoliosis (AIS) typically lead normal functioning lives. The Oswestry Disability Index (ODI) is a validated questionnaire for assessing back disability with 0-20 indicating minimal disability. A score of >30 has been used in past FDA trials as an inclusion criterion for surgical studies. We predict that increasing ODI scores will correlate with age, curve size, curve location and progression to surgery. PURPOSE To analyze ODI scores in unoperated adults with AIS to better understand the natural history and its potential correlation with progression to surgery. STUDY DESIGN/SETTING Single center retrospective study. PATIENT SAMPLE A total of 249 patients (pts) identified and 214 pts with ODI scores available were analyzed. OUTCOME MEASURES ODI score with respect to age, curve size, and curve location. Surgical rates in adults with AIS. METHODS All unoperated adult (≥20yrs) AIS pts seen in a tertiary deformity clinic from 2008-2018 were reviewed. Demographics, curve size [thoracic (T) and thoracolumbar (TL)], comorbidities, and ODI were collected. ODI scores ≥20 and ≥30 were analyzed across 3 age groups: 20-39 yrs (G1), 40-59 yrs (G2), and ≥60 yrs (G3). Differences between categorical and continuous variables were analyzed. Subgroup analyses based on ODI score groups, T vs TL curves, and pts progressing to surgery with T ≥50° and/or TL ≥40° only were also analyzed. Significance was defined as p RESULTS A total of 249 consecutive AIS pts were seen by one author over 10 yrs. Two hundred fourteen pts had ODI scores and were included. Mean age was 41 yrs (84% female). ODI scores had positive correlations with age, BMI, and curve size (p CONCLUSIONS ODI scores positively correlated with age, BMI, and coronal Cobb in adults with AIS. Pts age 20-59 tended to have ODI scores lower than 30. Despite “surgical size” curves, few (10%) adults seeking evaluation for scoliosis went on to surgery and those who did reported higher ODI scores than their nonsurgical counterparts. Pediatric deformity surgeons can use this information when counseling skeletally mature AIS patients and their families regarding the need for surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.