Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for adolescent idiopathic scoliosis: a case-control study

Abstract

Study design: A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age with either distraction and fusion using Harrington rods (ST, n = 156; 145 females and 11 males) or with brace (BT, n = 127; 122 females and 5 males), were followed at least 20 years after completion of the treatment.

Objectives: To determine the long-term outcome in terms of spinal mobility and muscle strength and its possible correlations to present back pain and function in patients surgically or brace treated for AIS.

Summary of background data: Few reports on long-term outcome on these variables have previously been presented for this group of patients.

Methods: A total of 135 (87%) of ST and 102 (80%) of BT patients underwent a complete examination by two unbiased observers incl. evaluation of lumbar muscle endurance and spinal mobility, curve size (Cobb method), validated questionnaires in terms of general and disease-specific quality of life aspects, as well as present back function and pain. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations.

Results: For both ST and BT groups, lumbar spinal motion as well as muscle endurance were significantly decreased compared with controls. For ST patients, better lumbar extensor and flexor muscle endurance or lumbar spinal mobility correlated with a better physical function. The length of fusion into the lumbar spine correlated inversely with lumbar range of motion, but the finger-floor distance was not affected. BT patients with reduced lumbar spinal mobility experienced lumbar back pain more often than controls.

Conclusions: For both brace treated and surgically treated AIS patients, spinal mobility and muscle endurance were reduced more than 20 years after completed treatment. The physical function was not severely restricted.