Natural history of adolescent idiopathic scoliosis: A tool for guidance in decision of surgery of curves above 50°

Aina J. Danielsson

doi:10.1007/s11832-012-0462-7

Abstract

The purpose of this lecture was to give an overview of the natural history of adolescent idiopathic scoliosis (AIS), in order to serve as guidance in the decision of performing surgery or not for the specific patient with AIS. A literature review was performed. Studies concerning long-term outcome in patients with adolescent idiopathic scoliosis that had received no treatment were used. Outcome in terms of curve size, pulmonary function, back function and quality or life/social life was compared. The literature review showed that single thoracic curves of 50°-75° progress 0.73°/year over a 40-year period. AIS do not result in increased mortality, but pulmonary symptoms may be associated with larger curves. Back pain is more frequent among patients with AIS. No study using modern quality of life questionnaires exists, but for social function, childbearing, and marriage no apparent disadvantageous effects were reported compared to the healthy population. The conclusion is that most individuals with AIS and moderate curve size around maturity function well and lead an acceptable life in terms of work and family. Some patients with larger curves have pulmonary problems, but not to the extent that this affects the life span. This needs to be taken into account when discussing surgery with the individual patient.

Highlights

Most surgeons indicate surgery for curves above 50° in patients with adolescent idiopathic scoliosis (AIS)
The purpose of this paper was to give a concise overview of the natural history of adolescent idiopathic scoliosis
Nilsonne found that mortality increased 2.2 times in all patients with idiopathic scoliosis and 3.2 times for patients above 45 years of age

Summary

Introduction

Most surgeons indicate surgery for curves above 50° in patients with adolescent idiopathic scoliosis (AIS). A curve size of 50–80° can be considered more of a grey zone for the decision on performing surgery. The indications used are sometimes hazy and are not always clearly expressed, and concerns include future pulmonary problems and impairment of back function, as well as cosmetic concerns. The patient needs correct information in order to be able to make a well-supported decision. The deformity itself might progress and cause an increased cosmetic problem for some patients. An increase of the curve size further adds to the reduction of the pulmonary function. The impact on the patient’s general function, i.e., in the social life as well as in the working life and quality of life, is of great importance to many patients. The base for decision-making is complex and multifaceted

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