Health and Function of Patients With Untreated Idiopathic Scoliosis: A 50-year Natural History Study

JAMA. 2003 Feb 5;289(5):559-67. doi: 10.1001/jama.289.5.559.

Abstract

Context: Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history.

Objective: To present the outcomes related to health and function in untreated patients with LIS.

Design, setting, and patients: Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years).

Main outcome measures: Mortality, back pain, pulmonary symptoms, general function, depression, and body image.

Results: The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain.

Conclusions: Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Back Pain / etiology
  • Body Image
  • Cause of Death
  • Depression / etiology
  • Disease Progression
  • Dyspnea / etiology
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Scoliosis / mortality
  • Scoliosis / psychology
  • Severity of Illness Index