Impact of unoperated adolescent idiopathic scoliosis in adulthood: a 10-year analysis

Abstract

Study design: Retrospective, cross-sectional.

Objective: To evaluate the impact of unoperated adolescent idiopathic scoliosis (AIS) in adulthood on pain, quality of life, and need for operative management.

Background: Long-term studies of AIS in adulthood demonstrate most patients function well, though some have increased disability. The Oswestry Disability Index (ODI) and SRS-22r are validated questionnaires for assessing back disability and quality of life. Correlation of these questionnaires to patient outcomes and necessity for surgery have not been fully defined.

Methods: Unoperated adults with AIS seen in a tertiary deformity clinic from 2008-2018 were identified. Variables included demographics, comorbidities, family history, curve size/location, pain score, ODI, SRS-22r, and previous treatment. ODI and SRS-22r scores were analyzed across three age groups: 20-39, 40-59, and ≥ 60.

Results: 275 eligible patients were identified and 255 (93%) patients had an ODI and/or SRS-22r score. ODI scores (220 patients) had a positive correlation with age, BMI, and curve size (p < .001). SRS-22r (204 patients) pain score was worse in all age-gender-matched domains (p < .05). Of the 255 patients in the study, 10% underwent surgery after presentation. In 118 patients with surgical-size curves (thoracic ≥ 50°; thoracolumbar ≥ 40°), no difference was seen in age or curve size between surgical and non-surgical patients; however, ODI and SRS-22r scores (excluding mental health) were significantly worse in surgical patients (p ≤ .01).

Conclusions: Patients with AIS have SRS-22r scores that are lower than age-gender-matched controls in most domains. ODI had a positive linear correlation with age, body mass index, and curve size. Only 10% of adults with surgical-size curves evaluated for scoliosis elected to undergo surgery. Patients treated surgically reported worse preoperative quality-of-life scores than their non-surgical counterparts. These results can help healthcare providers when counseling patients and families concerning management options.

Level of evidence: III.

Keywords: Adolescent idiopathic scoliosis; Natural history; Patient reported outcomes; Surgery.