Scoliosis back: Don't just "watch and wait"

Written by  Clayton Stitzel
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The rationale behind observing a mild scoliosis is that, once a patient reaches the age of 18, the scoliosis will not progress.  However, this is not supported by research.  It has been known since 1969 that scoliosis can continue to progress after skeletal maturity.82  Collis & Ponseti followed 215 cases of scoliosis after maturity; and documented an average worsening of 15 degrees.83 Weinstein et al showed that 68% of cases of scoliosis progress after skeletal maturity.84  Korovessis et al reported a mean progression of 2.4 degrees per year over the course of 5 years in skeletally mature patients.85  Danielson & Nachemson found that 36% of adolescents with scoliosis had progressed by more than 10° after 22 years.86

Idiopathic scoliosis (IS) is often described as asymptomatic, but it is often associated with changes in pulmonary function – even patients with mild IS may present with reduced lung capacity.8-94  Patients with no readily apparent pulmonary deficiencies may reveal decreased ventilatory function during maximal exercise.95,96  Cosmetic appearance and self-image can be affected.97-102  Pain increases in incidence & severity with age in both adolescents & adults.103-107

 

References:

 

  1. Marty-Poumarat C, Scattin L, Marpeau M, Garreau de Loubresse C, Aegerter P: Natural History of Progressive Adult Scoliosis. Spine 2007;32(11):1227-1234.  
  2. Collis DK, Ponseti IV: Long-term follow-up of patients with IS not treated surgically. J Bone Joint Surg, 1968;51A:425-445.
  3. Weinstein SL, Ponseti IV: Curve progression in IS. J Bone Joint Surg, 1983;65A:702-712.
  4. Korovessis P, Piperos G, Sidiripoulos P, et al. Adult idiopathic lumbar scoliosis. Spine 1994;190:1926-1932.
  5. Danielson AJ, Nachemson AL. Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: A case control study-Part I. Spine 2003;28:2078-2166.
  6. Kleinberg S: The operative treatment of scoliosis. Arch Surg 1922, 5:631-45.
  7. Hawes M: Impact of spine surgery on signs and symptoms of spinal deformity. Pediatric Rehabilitation 2006; 9(4): 318-339.
  8. Szeinberg A, Canny G, Rashed N, Veneruso G, Levison H: Forced vital capacity and maximal respiratory pressures in patients with mild and moderate scoliosis. Pediatric Pulmonology 1987; 4(1):8-12.
  9. Vedantam R, Crawford A: The role of preoperative pulmonary function tests in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.  Spine 1997;22(23):2731-2734.
  10. Kearon C, Viviani GR, Kirkley A, Killian KJ: Factors determining pulmonary function in adolescent idiopathic scoliosis.  Am Rev Respir Dis. 1993;148(2):288-294.
  11. Smyth R, Chapman K, Wright T, Crawford J, Rebuck A: Pulmonary function in adolescents with mild IS.  Thorax 1984;39(12):901.
  12. Zaba R: Peak expiratory flow in children and adolescents with idiopathic scoliosis.  Wiad Lek. 2003;56(11-12):552-5. 
  13. Koumbourlis A: Scoliosis and the respiratory system. Paediatric Respiratory Reviews 2006; 7:152–160.
  14. Barrios C, PĂ©rez-Encinas C, Maruenda J, LaguĂ­a M: Significant ventilator functional restriction in adolescents with mild or moderate scoliosis during maximal exercise tolerance test. Spine 2005;30(14):1610-1615.
  15. Alves VL, Avanzi O: Objective assessment of the cardiorespiratory function of adolescents with idiopathic scoliosis through the six-minute walk test. Spine 2009;34(25):E926-E929.
  16. Lonstein J: Idiopathic scoliosis. In: Lonstein J, Bradford D, Winter R, Oglivie J, ed., Moe’s Textbook of scoliosis and other spinal deformities. 3rd ed., Philadelphia, PA: W.B. Saunders; 1995:219-256.
  17. Payne W, Oglivie J, Resnick M, Kane R, Transfeldt E, Blum R: Does scoliosis have a psychological impact and does gender make a difference? Spine 1997;22:1380-1384.
  18. Smith F, Latchford G, Hall R, Milner P, Dickson R: Indications of disordered eating behavior in adolescent patients with idiopathic scoliosis. JBJS 2002;84-B:392-394.
  19. Friedel K, Petermann F, Reichel D, Steiner A, Warschburger P, Weiss H: Quality of life in women with IS. Spine 2002;27:E87-E91.
  20. Korovessis P, Zacharatos S, Koureas G, Megas P: Comparative multifactorial analysis of the effects of idiopathic adolescent scoliosis and Scheuermann kyphosis on the self-perceived health status. Eur Spine J. 2007;16(4):537-546.
  21. Tones M, Moss N, Polly D: A review of quality of life and psychosocial issues in scoliosis. Spine 2006;31(26):3027-3038.
  22. Ramirez N, Johnston C, Browne R: Prevalence of back pain in children who have IS. JBJS 1997;79-A:364-368.
  23. Brown D: The pain drawing in AIS.  Proceedings of the SRS Annual 36th meeting, Cleveland Oh, 2001.
  24. Schwab F, Dubey A, Pagala M, Gamez L, Farcy J, Pagala M: Adult scoliosis: a health assessment analysis by SF-36. Spine 2003;28:602-606.
  25. Mayo N, Goldberg M, Poitras B, Scott S, Hanley J: The Ste-Justine AIS cohort study: back pain. Spine 1994;19:1573-1581.
  26. Weinstein S, Dolan L, Spratt K, Peterson K, Spoonamore M, Ponseti I: Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 2003;289:559-567.
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