Nonoperative treatment for adolescent idiopathic scoliosis: a 10- to 60-year follow-up with special reference to health-related quality of life.

STUDY
DESIGN: Retrospective study on patients 10 to 60 years of age after nonoperative treatment for adolescent idiopathic scoliosis (AIS).
OBJECTIVES: To investigate long-term outcome with regard to pain, disability, psychological disturbance, and health-related quality of life (HRQOL) in nonoperatively treated patients with AIS. SUMMARY OF BACKGROUND DATA: Only little is known on the long-term quality of life and disability in patients nonoperatively treated for AIS. A detailed knowledge of the nonoperative treatment results is important when advising patients for surgery.
METHODS: A total of 135 nonoperatively treated AIS patients with a minimum follow-up of 10 years were included in this investigation, 121 of whom responded to a questionnaire containing questions on pain, disability (Oswestry Disability Index [ODI], Hannover Functional Ability Questionnaire [HFAQ], psychological general well-being [PGWB], and health-related quality of life [WHOQOLBREF]). Eighty-one patients participated in a clinical/radiologic follow-up examination. Nonoperative treatment consisted of bracing (n = 60), physiotherapy (n = 59), and electrical stimulation (n = 2). The overall follow-up rate was 89.6%. The mean age at follow-up was 38.0 years (range, 20-73 years.).
RESULTS: In general, patients achieved a satisfactory outcome 10 to 60 years (mean, 23 years) after nonoperative treatment with regard to pain, disability, and HRQOL. The average curve at first diagnosis measured 29.5 degrees (range, 15 degrees -59 degrees ) for the thoracic spine, 21.3 degrees (range, 15 degrees -28 degrees ) for the thoracolumbar spine, and 26.8 degrees (10 degrees -44 degrees ) for the lumbar spine. Thirteen patients showed a substantial change in curve size (+/-10 degrees ) between first diagnosis and end of growth: 11 curves progressed more than 10 degrees showing an average increase of 19.0 degrees (range, 12 degrees -30 degrees ) and 2 patients presented with less severe curves at follow-up (-10 degrees and -13 degrees ). After end of growth, 7 patients showed a substantial average increase of 16.3 degrees (range, 10 degrees -31 degrees ). Five of eight patients with thoracic curves greater than 80 degrees had restrictive pulmonary disease. Patients with curves greater than 45 degrees reported significantly higher pain levels than those with smaller curves. Patients only showed a minimal absolute disability (Oswestry and HFAQ), and no significant correlation was found between curve size and curve type, respectively. Compared with a healthy control group that was matched for age and gender, no significant differences were found in terms of HRQOL as assessed by the WHOQOLBREF questionnaire. No significant differences in pain, disability, or HRQOL were found between patients with and without brace treatment.
CONCLUSIONS: Although pain, disability, HRQOL, and psychological general well-being are quite satisfactory on an absolute level, curve size was found to be a significant predictor for pain in a long-term follow-up.