Untreated Idiopathic Scoliosis Research Articles

Prediction of future curve angle using prior radiographs in previously untreated idiopathic scoliosis: natural history from age 6 to after the end of growth (SOSORT 2022 award winner)

PurposeTreatment selection for idiopathic scoliosis is informed by the risk of curve progression. Previous models predicting curve progression lacked validation, did not include the full growth/severity spectrum or included treated patients.The objective was to develop and validate models to predict future curve angles using clinical data collected only at, or both at and prior to, an initial specialist consultation in idiopathic scoliosis.MethodsThis is an analysis of 2317 patients with idiopathic scoliosis between 6 and 25 years old. Patients were previously untreated and provided at least one prior radiograph prospectively collected at first consult. Radiographs were re-measured blinded to the predicted outcome: the maximum Cobb angle on the last radiograph while untreated. Linear mixed-effect models were used to examine the effect of data from the first available visit (age, sex, maximum Cobb angle, Risser, and curve type) and from other visits while untreated (maximum Cobb angle) and time (from the first available radiograph to prediction) on the Cobb angle outcome. Interactions of the first available angle with time, of time with sex, and time with Risser were also tested.ResultsWe included 2317 patients (83% of females) with 3255 prior X-rays where 71% had 1, 21.1% had 2, and 7.5% had 3 or more. Mean age was 13.9 ± 2.2yrs and 81% had AIS. Curve types were: 50% double, 26% lumbar/thoracolumbar-lumbar, 16% thoracic, and 8% other. Cobb angle at the first available X-ray was 20 ± 10° (0–80) vs 29 ± 13° (6–122) at the outcome visit separated by 28 ± 22mths.In the model using data at and prior to the specialist consult, larger values of the following variables predicted larger future curves: first available Cobb angle, Cobb angle on other previous X-ray, and time (with Time2 and Time3) to the target prediction. Larger values on the following variables predicted a smaller future Cobb angle: Risser and age at the first available X-ray, time*Risser and time*female sex interactions. Cross-validation found a median error of 4.5o with 84% predicted within 10°.Similarly, the model using only data from the first specialist consult had a median error of 5.5o with 80% of cases within 10° and included: maximum Cobb angle at first specialist consult, Time, Time2, age, curve type, and both interactions.ConclusionsThe models can help clinicians predict how much curves would progress without treatment at future timepoints of their choice using simple variables. Predictions can inform treatment prescription or show families why no treatment is recommended. The nonlinear effects of time account for the rapid increase in curve angle at the beginning of growth and the slowed progression after maturity. These validated models predicted future Cobb angle with good accuracy in untreated idiopathic scoliosis over the full growth spectrum.

The importance of the size of the trunk inclination angle in the early detection of scoliosis in children

BackgroundEarly detection of idiopathic scoliosis is one factor in determining treatment effectiveness. Therefore, the aim of this study was to assess the importance of the size of the trunk inclination angle (ATI) for the early detection of scoliosis in preschool- and school-age children, taking into account the location and size of the spine curvature.MethodsThe study included a group of 216 children (mean age 11.54 years, standard deviation ± 3.05), who had previously untreated idiopathic scoliosis and a Cobb angle of ≥ 10°. The ATI values were compared with the corresponding Cobb angle values. The results of the ATI-Cobb correlation were compared to the ATI thresholds of 5° and 7°.ResultsIn the age groups 6–9, 10–12 and 13–17 years, the method sensitivity for the ATI ≥ 7° criterion was low at 33.90%, 27.69% and 51.29% (p < 0.05), respectively, while for the ATI ≥ 5° criterion, it was 67.8%, 69.23% and 93.48% (p < 0.05), respectively. With respect to location, significantly more frequent misdiagnoses (p < 0.05) were related to the lumbar and thoracolumbar (regions) sections of the spine in the groups aged 6–9 and 10–12 for ATI ≥ 7°; while no significant relationship was found at ATI ≥ 5°. For both ATI levels, the most frequent cases of mis- or undiagnosed scoliosis were observed among children with a Cobb angle of 10°-14° (p = 0.004).ConclusionA low predictive ATI value was demonstrated regarding scoliosis detection for the ATI 7° criterion in children aged 6–9 and 10–12 years, particularly for the lumbar and thoracolumbar locations. Adoption of the threshold of ATI 5° in screening tests for children aged 6–12 years, as well as for lower locations of scoliosis, may be more effective in the early detection of scoliosis.Trial registration.This study was approved by the Jan Dlugosz University in Czestochowa Ethics Committee KE-U/7/2021, and conducted under the Declaration of Helsinki.

Outcome of Surgery for Adolescent Idiopathic Scoliosis

Research Article| December 01 2019 Outcome of Surgery for Adolescent Idiopathic Scoliosis AAP Grand Rounds (2019) 42 (6): 64. https://doi.org/10.1542/gr.42-6-64 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Outcome of Surgery for Adolescent Idiopathic Scoliosis. AAP Grand Rounds December 2019; 42 (6): 64. https://doi.org/10.1542/gr.42-6-64 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: adolescent idiopathic scoliosis, surgical outcome, pain Source: Helenius L, Diarbakerli E, Grauers A, et al. Back pain and quality of life after surgical treatment for adolescent idiopathic scoliosis at 5-year follow-up: comparison with healthy controls and patients with untreated idiopathic scoliosis. J Bone Joint Surg Am. 2019; 101(16): 1460– 1466; doi: https://doi.org/10.2106/JBJS.18.01370Google Scholar Investigators from multiple institutions in Finland and Sweden conducted a case control study to compare long-term pain and quality of life in patients with adolescent idiopathic scoliosis (AIS) who underwent surgical treatment, consisting of posterior spinal fusion with pedicle screws, to that of untreated AIS patients and individuals without AIS. Cases were patients with AIS who underwent surgical treatment when they were between 12 and 19 years old at a single center by a single orthopaedic surgeon. These patients completed the Scoliosis Research Society-24 (SRS-24) questionnaire at minimum of 5 years after surgical treatment for AIS. The SRS-24 is designed to measure disease-specific quality of life across multiple domains. The 2 sets of controls were selected from the populations of other studies conducted by the authors1,2 ; one control from each set was age- and gender-matched to a case. The untreated AIS control group was patients from 1 of 6 centers in Sweden who were diagnosed with AIS when they were 10–17 years old and had a Cobb angle of ≥10°. Healthy controls were selected from the general population in Sweden. Participants in both control groups completed the SRS-22r, which is a revised version of the SRS-24. For the study, SRS-24 scores from 4 domains in cases, including pain, self-image, function, and activity, were compared to SRS-22r scores in controls for the same domains. Wording of the specific questions in these domains in the SRS-24 or SRS-22r are either the same or close. Scores between the cases and 2 control groups were compared using ANOVA. There were 49 cases with AIS who underwent surgical treatment. Mean Cobb angle in these individuals was 53.2° + 7.3° preoperatively, and 11.7° + 6.0° at 2 years postoperatively. The mean age of cases was 22 years, and they had a mean follow-up period of 6.2 years. Among those in the untreated AIS group, the mean Cobb angle at the time of diagnosis was 27.7° + 10.1°. Scores for the domains of pain, self-image, and activity were significantly better in cases than in untreated AIS controls (P values <.001, .014, and <.001, respectively); there was no significant difference between these groups in the domain of function (P=.26). There were also no significant differences for the domains of pain, self-image, and activity between cases and healthy controls, but scores in the domain of function were significantly better in healthy controls than in cases (P<.001). The authors conclude that patients with surgical treatment of AIS had improved pain and health-related quality of life compared to those with untreated AIS. Dr Hennrikus has disclosed no financial relationship relevant to this commentary.... You do not currently have access to this content.

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

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.

Sagittal alignment and thoracolumbar osteotomies

Sagittal imbalance is most commonly seen in patients with multilevel degenerative disc disease, inflammatory arthropathies, severe osteoporosis, and untreated idiopathic scoliosis. The degree of imbalance is closely correlated with clinical symptoms. Sagittal deformity can occur from a variety of causes in both young and elderly patients, however it has been found to most likely be multifactorial. Other causes include Scheuermann's Kyphosis, iatrogenic flat-back, post-traumatic, neuromuscular, and congenital disorders such Klippel–Feil and infantile scoliosis. Clinical evaluation includes a thorough health history and physical examination, as well as more advanced methods such as surface topography and 3D postural analysis. The determination to utilize an osteotomy during deformity surgery is based on many factors including the patient's global sagittal alignment and radiographic assessment, the amount of correction needed to restore proper alignment, the relative rigidity of the deformity, and any focal areas of severe angulation. The three most commonly utilized osteotomies are discussed below including the posterior column Smith–Peterson/Ponte osteotomy, as well as the three-column pedicle subtraction osteotomy and vertebral column resection. The goal of a corrective osteotomy is to normalize the local segment's curve in order to correct the overall global spinal alignment and improve patient function. Complication rates as high as 25–40 percent have been reported in literature.

Health-related Quality of Life and Body Image Disturbance of Adolescents With Severe Untreated Idiopathic Early-onset Scoliosis in a Developing Country.

A cross-sectional study. This study aimed to investigate the health-related quality of life (HRQOL) and body image disturbance of adolescents with untreated severe idiopathic early-onset scoliosis (IEOS) in a developing country. IEOS has the potential to progress rapidly and may lead to significant disability if left untreated. Moreover, it can lead to significant body image changes that may lead to social and psychological stresses on developing adolescents. In developing countries, untreated severe IEOS among adolescents is common. The Scoliosis Research Society 22 revision (SRS-22r) Arabic version questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) were used to investigate the HRQOL and body image disturbance of these patients. A total of 137 patients with untreated severe IEOS (mean age, 15.5 years; range, 12-21 years) were included: group 1 (76 patients) with major curve angles of 90° to 120°, group 2 (61 patients) with major curve angles above 120°, and group 3 comprising 50 healthy controls were used for comparison. No significant differences were found regarding age, sex, and body mass index among the groups. Group 1 had significantly lower scores than group 3 in all SRS-22r domains (P < 0.001). Group 2 had significantly lower scores than group 1 in all SRS-22r domains, except for satisfaction (P < 0.005); the satisfaction domain had 100% worst answers in groups 1 and 2. Group 2 had worse scores than group 1 in all BIDQ-S questions (P < 0.001). No significant differences were found between males and females in all SRS-22r domains and BIDQ-S questions (P > 0.05). Further, 13% to 100% and 25% to 71% of the patients provided the worst answers to the SRS-22r and BIDQ-S questions, respectively. The HRQOL and body image of the adolescents with untreated severe IEOS in a developing country were severely impaired. 3.

Exercise efficiency of adolescents with idiopathic scoliosis in and without Cheneau brace

Background Untreated idiopathic scoliosis (IS) may lead to large deformations of the trunk, limiting capacity and biomechanics functions of the chest and exercise capacity, which is closely related to changes in the functioning of the cardio-pulmonary system. The conservative treatment of IS is applied in a brace treatment and various methods of physiotherapy. However, the usage of the brace may additionally decrease the cardio-pulmonary efficiency, regardless of what the beneficial effects of persistent brace therapy might be. Purpose The goal of this study was to observe whether a Cheneau brace (ChB) affects the exercise capacity (ExC) among the patients with IS based on the analysis of the two forms of exercise: Cycle Ergometer Test (CET) and the 6-Minute Walk Test (6MWT). Additional goals were to determine the relationship between factors such as curvature size (Cobb), the deformation extent and the degree of a direct effect of the ChB on ExC. Methods Fifty-Six patients (10-18 years) with diagnosed IS, who passed through the CET and the 6MWT. Tests were performed twice: once in a brace and once without it. Design: A randomized, controlled trial. Results The study showed a disability of the exercise test parameters on the CET during the test with a ChB compared to the test without a ChB. The search for a correlation between the degree and location of the scoliosis, the thoracic kyphosis degree, children’ sa ge and the CET parameters exercise test failed in most cases. The significantly shorter average distance of 6MWT was founded in the children’s group wearing a brace compared to the group without the brace. Conclusions and discussion A ChB significantly limits the ExC. The impairment of this capacity has been demonstrated in both tests for CET and 6MWT. Both exercise tests had limited utility in assessing the negative effect of the degree and location of scoliosis on some parameters in these trials. More useful in this aspect was a 6MWT, in which was found a significant inverse correlation between the thoracic kyphosis degree and the difference in march distance with and without a brace.

Use of the Scoliosis Research Society Outcomes Instrument to Evaluate Patient Outcome in Untreated Idiopathic Scoliosis Patients in Japan

This study clarifies the relation between the results of the Scoliosis Research Society Outcomes Instrument (SRS-24) and radiographic parameters of back deformity in Japanese idiopathic scoliosis patients. To investigate the relation between magnitude of back deformity and results of the SRS-24 in untreated patients. In idiopathic scoliosis, it is necessary to clarify the relation between patient-perceived outcomes of the deformity and magnitude of back deformity before considering treatment. The relation between the magnitude of spinal deformity and outcomes of untreated patients, however, has not been fully investigated. Patients (n = 166) under 30 years of age with untreated scoliosis were evaluated. Radiologic examination included Cobb angle, rotation angle of apical vertebrae, and translation of C7 vertebra from the central sacral line (C7 translation) on the coronal plane. Patient evaluation using section 1 (15 questions) of the SRS-24 was compared with radiologic findings using Spearman's correlation coefficient by rank (rs). The average pain domain score was 27.0 +/- 2.2 points, general self-image 9.9 +/- 1.7 points, general function 12.7 +/- 1.1 points, and overall level of activity 14.9 +/- 0.6 points. In radiologic deformity, the average Cobb angle and rotation angle of the thoracic curve were 35.8 degrees +/- 12.1 degrees (range, 17 degrees-73 degrees) and 13.9 degrees +/- 8.2 degrees (range, 0 degrees-38 degrees), respectively. The average Cobb and rotation angle of the lumbar curve were 31.4 degrees +/- 9.3 degrees (range, 13 degrees-56 degrees) and 15.4 degrees +/- 9.7 degrees (range, 2 degrees-36 degrees), respectively. The mean C7 translation was 12.4 +/- 9.7 mm (range, 0-48 mm). Comparison between individual domains and radiologic measurements revealed that the total pain (rs = -0.33; P < 0.0001) and general self-image (rs = -0.25; P = 0.0024) domain scores had a significant inverse correlation with thoracic curve Cobb angle. Comparison between the scores of individual questions and radiologic measurements revealed that the scores of question 3 (total pain domain) had a significant inverse correlation with thoracic curve Cobb angle (rs = -0.36; P < 0.0001). The scores of question 5 (general self-image domain) had a significant inverse correlation with thoracic curve Cobb angle (rs = -0.41; P < 0.0001) and rotation angle (rs = -0.30; P = 0.0006). The patients did not have negative self-image regarding back appearance when the thoracic curve Cobb angle was less than 30 degrees but had a negative self-image when the thoracic curve Cobb angle was more than 40 degrees and the rotation angle was more than 20 degrees. On the other hand, the lumbar curve Cobb angle and the rotation angle did not correlate with patient self-image. The results of the present study will help to define the parameters for the initiation of active treatment and physicians should maintain or reduce scoliotic deformity so that the thoracic curve Cobb angle is less than 40 degrees and the rotation angle is less than 20 degrees in idiopathic scoliosis.

Use of the Scoliosis Research Society Outcomes Instrument to Evaluate Patient Outcome in Untreated Idiopathic Scoliosis Patients in Japan

This preliminary study evaluates untreated Japanese patients with idiopathic scoliosis using the Scoliosis Research Society Outcomes Instrument (SRS-24). To determine the baseline patient outcome score using the SRS-24 for untreated Japanese scoliosis patients compared with a nonscoliosis group. The SRS instrument with 24 questions was developed to help evaluate patient-perceived outcomes of idiopathic scoliosis treatment. Evaluation of untreated Japanese idiopathic scoliosis patients using the SRS instrument has not been reported. Japanese idiopathic scoliosis patients (n = 141) (mean age, 13.6 years; range, 10-17 years) with a Cobb angle of more than 20 degrees who were not treated with a brace or surgery, were evaluated in comparison with a nonscoliosis group (healthy junior high school students; n = 72) using the SRS-24. The scoliosis group was categorized as mild deformity group with a major curve Cobb angle of less than 30 degrees, moderate deformity group with 30 degrees to 49 degrees, and severe deformity group with more than 50 degrees. The patients were evaluated using section 1 (15 questions) of the SRS-24, which was divided into four domains: total pain, general self-image, general function, and activity. Reliability, as determined by internal consistency, was validated using Cronbach's alpha for these domain scales. The severe deformity group had the lowest scores compared with the other deformity groups and the nonscoliosis group in pain (P < 0.0001) and self-image (P < 0.05) domains. The scores for questions 3 (P < 0.0001) and 5 (P < 0.0001), evaluation of self-image of back appearance, were significantly lower in the scoliosis group than those in the nonscoliosis group. This tendency was more significant in the patients with greater curve magnitude. Scores for questions 14 and 15, evaluation of general self-image, in the scoliosis group were, however, higher than those in the nonscoliosis group. Internal consistency using Cronbach's alpha was 0.57 (pain), 0.27 (general self-image), -0.08 (general function), and 0.15 (overall level of activity). Untreated scoliosis patients with severe deformity were inclined to complain of being self-conscious or distressed regarding their back appearance compared with age- and sex-matched control adolescents. The control group was inclined to have, however, a negative general self-image compared with the patients group. Internal consistency using Cronbach's alpha for all domains was considerably low. The baseline of the SRS-24 scores in the Japanese population might differ from that of the Western population because of differences in national culture. Therefore, further study is necessary to clarify the validity of the SRS-24 domains for Japanese patients.

Comment regarding ?Gait analysis in patients with idiopathic scoliosis?

Sir, As the upper torso and the spine are supported by the pelvic girdle and the lower limbs, a deformity of the spine will certainly affect the gait. While gait changes have been previously reported in patients who have undergone long spinal fusions, relatively little abnormalities have been found in most of the common gait parameters in patients with untreated idiopathic scoliosis. The authors of the present paper have performed a very comprehensive analysis of the gait and the ground reaction forces in a small but homogenous group of patients. They have identified a definite asymmetry in the torsional offset of the trunk in relation to the rotating pelvis in the transverse plane which is not related to the severity of the curve or changed by bracing. Although these findings are interesting and unique, this study is limited by the small sample size and the large variation of patients’ age, curve magnitude, and curve types. Also, they have not correlated the findings with the flexibility of the curve which could affect the dynamic asymmetries and movement strategies. The results are also not able to shine light on one of the proposed goals of the study of whether the asymmetry is the cause or effect of the scoliosis. As such, the clinical value of this paper is still to be seen. Nevertheless, the authors should be commended on this good work and be encouraged to pursue further studies in this field.

Health and Function of Patients With Untreated Idiopathic Scoliosis--Reply

Health and Function of Patients With Untreated Idiopathic Scoliosis--Reply

The Natural History of Untreated Adolescent Idiopathic Scoliosis

Orthopedics| May 01 2003 The Natural History of Untreated Adolescent Idiopathic Scoliosis AAP Grand Rounds (2003) 9 (5): 57–58. https://doi.org/10.1542/gr.9-5-57 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation The Natural History of Untreated Adolescent Idiopathic Scoliosis. AAP Grand Rounds May 2003; 9 (5): 57–58. https://doi.org/10.1542/gr.9-5-57 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: adolescent idiopathic scoliosis, idiopathic scoliosis Source: Weinstein SL, Dolan LA, Spratt KF, et al. Health and function of patients with untreated idiopathic scoliosis. JAMA. 2003;289:559–567. The authors from the Universities of Iowa and Southern California report a 50-year prospective study of a cohort of untreated patients with late-onset idiopathic scoliosis (LIS), defined as a structural lateral spinal curvature occurring during puberty in otherwise healthy adolescents. The diagnosis of LIS was made at the University of Iowa between 1932 and 1948. One hundred seventeen of 314 eligible patients comprised the study group. Their mean age was 66 years. Follow-up studies of this cohort were reported at 30 and 40 years. For this study, 62 age- and sex-matched controls were included. Outcome measures were mortality, pulmonary symptoms, general function, depression, and body image. Data from the 30- and 40-year follow-up studies were used for longitudinal comparisons. Radiographic and physical examinations were performed.... You do not currently have access to this content.

Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.

Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. To present the outcomes related to health and function in untreated patients with LIS. Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). Mortality, back pain, pulmonary symptoms, general function, depression, and body image. The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

Surgical treatment of idiopathic adolescent scoliosis.

This article represents one investigator’s attempt to interpret current-day literature regarding surgical treatment of adolescent idiopathic scoliosis. The issues that will be discussed are the following: the classification of idiopathic adolescent scoliosis; the natural history of treated compared with untreated idiopathic scoliosis; the current spectrum of considerations for surgical treatment; the advantages and disadvantages of present segmental spinal instrumentation compared with the Harrington system; the effect of implants on the spine and the spectrum of instrumentation philosophies and kinds of implants, both anterior and posterior; complications of surgical treatment; and current issues of debate about crankshaft phenomenon and various options of bone grafting.

Spinal growth and progression of adolescent idiopathic scoliosis

The spinal growth in scoliotic segments (T4-L4) of 110 girls with untreated idiopathic scoliosis was measured from two successive radiographs taken at a mean interval of 1.1 years. At the first visit the mean age of the patients was 14 years (range 11-16 years), the mean magnitude of the major curves 24 degrees (range 9 degrees-38 degrees) and that of the minor curves 14 degrees (range 2 degrees-38 degrees). Spinal growth was most rapid at the age of 11-12 years. The progression of the curves (major plus minor) correlated with the spinal growth (r = 0.384). The greater the initial curves were, the stronger the correlation was between the spinal growth and the progression of the curves (r = 0.046-0.639), and the correlation was more significant in thoracic scoliosis (r = 0.560) than in thoracolumbar and lumbar scoliosis (r = 0.152).

Lung function in adult idiopathic scoliosis: a 20 year follow up.

Severe idiopathic scoliosis may lead to respiratory failure, which can be treated by assisted ventilation. Twenty four patients with surgically untreated idiopathic scoliosis who had been examined in 1968 were re-examined in 1988 to assess changes in lung function and risk factors for respiratory failure. The patients were aged 15-67 years in 1968 and had a scoliotic angle of 10-190 degrees and a vital capacity of 1.0-6.0 litres. Spirometric values and scoliotic angles were determined in 1968 and 1988, and arterial blood gas tensions in 1988. The decline in spirometric values over the 20 years was of the same magnitude as the predicted decline due to aging. Arterial blood gas tensions in 1988 were strongly correlated with the scoliotic angles and spirometric indices recorded in 1968. Hypoxaemia and hypercapnia was seen in four patients in 1988 (then aged 43-67 years) and these were the four patients who had a vital capacity below 43% predicted in 1968. The remaining 20 patients had blood gas values within normal limits. Two further patients had died from respiratory failure before 1988, so a total of six patients had developed respiratory failure. In a multiple logistic analysis vital capacity expressed as % predicted in 1968 was the strongest predictor of the development of respiratory failure, followed by the scoliotic angle. Respiratory failure occurred only in patients who had a vital capacity below 45% predicted in 1968 and an angle greater than 110 degrees. Thus respiratory failure develops in adults with scoliosis with a large angle and a low vital capacity when normal aging reduces the ventilatory capacity further. Such individuals merit close follow up.

Flexibility in structurally normal young females and in young females with idiopathic scoliosis

The bending stiffness of the trunk as related to ventral flexion was calculated in 10 young females with untreated idiopathic scoliosis and in 10 young females with structurally normal spines. Seven clinical measurements of joint flexibilities were also made. The ages of the subjects ranged from 10 to 16 years. The girls with scoliosis had similar or lower flexibility compared with the normal controls. The study provided no evidence that untreated scoliosis occurs or progresses because of increased flexibility. This report supports previous findings.

Pulmonary Function and Gas Exchange at Rest and Exercise in Adolescent Girls with Mild Idiopathic Scoliosis during Treatment with Boston Thoracic Brace

Pulmonary function and gas exchange at rest and during and after standard exercise on bicycle ergometer were studied in 49 girls, aged 10 to 16 years (mean, 13.7), with untreated idiopathic scoliosis, before and with Boston thoracic brace, and after treatment for 3 weeks, reducing the thoracic curve angle from a mean of 32.4 degrees (range, 19-60 degrees) to 17.3 degrees (range, 8-33 degrees). The bracing led to marked decrease in lung volumes, below functions, and CO transfer factor, moderate rise in resting O2 intake, CO2 output and ventilation, and marked rise in ventilatory and O2 cost of exercise, probably due to increased dead space ventilation and O2 cost of breathing. However, repeated studies after 1 day without brace, 6 months after onset of bracing, showed no persistent deterioration of pulmonary function or disturbances of gas exchange, as compared with the pre-bracing state.

Natural history of untreated idiopathic scoliosis after skeletal maturity : Ascani E, Bartolozzi R, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M.Spine 1986; 11: 784–789

Natural history of untreated idiopathic scoliosis after skeletal maturity : Ascani E, Bartolozzi R, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M.Spine 1986; 11: 784–789

Three-dimensional spinal curvature in idiopathic scoliosis.

Scoliosis is usually considered as a deformity of the spine in the frontal plane, without reference to curvatures in other planes. In this study, the three-dimensional shape of the spine of 104 patients with untreated idiopathic scoliosis (5-55 degrees Cobb) was studied by means of stereo radiographs to determine relationships between curvature of the spine in the frontal plane view, in the lateral view, and in the intermediate views. There was a weak but statistically significant correlation (r = 0.2) relating greater scoliosis with lesser kyphosis or greater lordosis. In the thoracic region, the sagittal plane spinal curvature was less than that measured in a population without scoliosis (mean difference, 7.72 +/- 9.9 degrees). Seventy-four of 76 scolioses in the upper region of the spine with lateral curvature greater than 5 degrees Cobb were kyphotic. Sixty-four of 84 curves greater than 5 degrees Cobb in the lower region were lordotic. Measuring curvatures in the plane of symmetry of the rotated apical vertebra altered these ratios to 69 of 76 kyphotic in the upper region and 68 of 84 lordotic in the lower region. The plane of maximum curvature of sections of the spine with scoliosis was not related to the plane of symmetry of the rotated apical vertebra, for in kyphotic regions of the spine the rotations of these two planes were in opposite directions. In all cases, the magnitudes of the rotations were quite different, i.e., by a factor of -0.22 for curves in thoracic region and by a factor of 0.24 for curves in the lumbar region. This implies that mechanical measures to correct this spinal deformity or to prevent progression should apply different rotations to the apex from those applied to the curve as a whole and, in opposite senses, in curves in kyphotic regions. There was no evidence of an abnormality of sagittal curvature of a magnitude to implicate it in the etiology or in the treatment.