Outcome of treatment for scoliosis. A multi-disciplinary follow-up at least 20 years after surgery or brace treatment in patients with adolescent idiopathic scoliosis with comparison to a matching control group

Sammanfattning: Introduction: The long term outcome of treatment for adolescent idiopathic scoliosis (AIS), with brace or surgery, has previously not been fully established.Aims: To evaluate the outcome in terms of radiological appearance, degenerative changes, pulmonary function and different aspects of health related quality of life at least twenty years after completed treatment.Patients and methods: 283 consecutive patients with AIS were treated before the age of twenty-one at Sahlgrenska University Hospital with either a brace (n=127, BT) or surgery with Harrington distraction and fusion (n=156, ST). 92% attended a follow-up by an unbiased examiner, radiography, spirometry and questionnaires with validated instruments for health related quality of life, back problems and respiratory symptoms. An age- and sex-matched control group without scoliosis (n=100), solicited at random, was examined in the same manner. Magnetic resonance imaging of the lower lumbar spine was performed in a subgroup of 32 ST patients and 32 controls.Results: The major curve of the ST patients had increased 4° from end of treatment to 36° increased 4° at present FU, and the curve of the BT patients had increased by 8°up to 38°. Two per cent of the patients, all BT, increased their curves more than 20° one needing surgery. The rate of postoperative complications was low and eight patients had been reoperated. Both patient groups had significantly more degenerative lumbar disc changes than the controls. On MRI, an increased frequency of degenerative changes in the lowest unfused disc in the ST group could be correlated to increased lumbar pain intensity, reduced lumbar lordosis but not to decreased function. Pulmonary function had improved after completed treatment in both ST and BT groups and was within normal ranges. The transition into adulthood was successful in the overwhelming majority of the patients; marriage and childbearing were the same as in the control group. No increased frequency of complications during pregnancy, incl. back pain, or delivery were noted among scoliotic subjects. The curve size was not influenced by the number of pregnancies or age at first pregnancy. The general psychological well-being of scoliotic patients was the same as for the general population, although many patients had found the prolonged treatment period a negative experience. Forty per cent also admitted that they felt unattractive or were limited by the back in social life. There was a slight, but significant reduction of the physical well-being of both groups compared to controls, although minimally reduced compared to other patient groups.Conclusions: The majority of the patients were well-functioning physically, psychologically and socially even if some had developed an increase of the curve (4%) or admitted problems known to be associated with the disease.