Poorer prognosis than previously thought
A study published in 2023 by Rigshospitalet in Copenhagen assesses outcomes in patients 40 years after diagnosis with idiopathic scoliosis (7–9). Three groups were observed, with an average age of 54 years. At the last contact with Rigshospitalet in adolescence, the average Cobb angle was 19 degrees in the observation group, 38 degrees in the group treated with a brace and 39 degrees in the group who underwent surgery. Forty years after diagnosis, the average Cobb angle had increased to 25, 55 and 47 degrees, respectively. Back pain was the main reason why 21 % of patients were unable to work full time, compared to 11 % in the corresponding general population. Just over half of those who were unable to work full-time had worn a brace. The scoliosis patients' quality of life was significantly lower than that of the corresponding general population.
A Canadian study published in 2019 compared surgery outcomes in adults and adolescents (5). The average age was 44 and 16 years, respectively. The adults experienced higher levels of pre-surgery pain and disability than the adolescents, but showed more improvement following surgery. However, they needed a significantly longer fusion due to degeneration of vertebrae.
There is now strong evidence that a Cobb angle of more than 30 degrees in unoperated, skeletally mature patients entails a high risk of gradual exacerbation of the deformity over years and decades, due to concurrent idiopathic and degenerative scoliosis (2, 4, 5, 7–9). Pain, disability and loss of quality of life may not occur until several decades later, when compensatory mechanisms have been exhausted (2, 4, 5, 7–9). In my opinion, this patient group should therefore receive regular follow-up to prevent worsening of the prognosis.