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Nonoperative Treatment for Adolescent Idiopathic Scoliosis: A 10- to 60-Year Follow-up With Special Reference to Health-Related Quality of Life

Haefeli, Mathias, Med Pract*; Elfering, Achim, Dipl Psych, PhD; Kilian, Reinhold, PhD; Min, Kan, MD*; Boos, Norbert, MD*

doi: 10.1097/01.brs.0000197664.02098.09
Health Services Research

Study Design. Retrospective study on patients 10 to 60 years of age after nonoperative treatment for adolescent idiopathic scoliosis (AIS).

Objectives. To investigate long-term outcome with regard to pain, disability, psychological disturbance, and health-related quality of life (HRQOL) in nonoperatively treated patients with AIS.

Summary of Background Data. Only little is known on the long-term quality of life and disability in patients nonoperatively treated for AIS. A detailed knowledge of the nonoperative treatment results is important when advising patients for surgery.

Methods. A total of 135 nonoperatively treated AIS patients with a minimum follow-up of 10 years were included in this investigation, 121 of whom responded to a questionnaire containing questions on pain, disability (Oswestry Disability Index [ODI], Hannover Functional Ability Questionnaire [HFAQ], psychological general well-being [PGWB], and health-related quality of life [WHOQOLBREF]). Eighty-one patients participated in a clinical/radiologic follow-up examination. Nonoperative treatment consisted of bracing (n = 60), physiotherapy (n = 59), and electrical stimulation (n = 2). The overall follow-up rate was 89.6%. The mean age at follow-up was 38.0 years (range, 20–73 years.).

Results. In general, patients achieved a satisfactory outcome 10 to 60 years (mean, 23 years) after nonoperative treatment with regard to pain, disability, and HRQOL. The average curve at first diagnosis measured 29.5° (range, 15°–59°) for the thoracic spine, 21.3° (range, 15°–28°) for the thoracolumbar spine, and 26.8° (10°–44°) for the lumbar spine. Thirteen patients showed a substantial change in curve size (±10°) between first diagnosis and end of growth: 11 curves progressed more than 10° showing an average increase of 19.0° (range, 12°–30°) and 2 patients presented with less severe curves at follow-up (−10° and −13°). After end of growth, 7 patients showed a substantial average increase of 16.3° (range, 10°–31°). Five of eight patients with thoracic curves greater than 80° had restrictive pulmonary disease. Patients with curves greater than 45° reported significantly higher pain levels than those with smaller curves. Patients only showed a minimal absolute disability (Oswestry and HFAQ), and no significant correlation was found between curve size and curve type, respectively. Compared with a healthy control group that was matched for age and gender, no significant differences were found in terms of HRQOL as assessed by the WHOQOLBREF questionnaire. No significant differences in pain, disability, or HRQOL were found between patients with and without brace treatment.

Conclusions. Although pain, disability, HRQOL, and psychological general well-being are quite satisfactory on an absolute level, curve size was found to be a significant predictor for pain in a long-term follow-up.

A total of 121 of 135 individuals, who had undergone nonoperative treatment for adolescent idiopathic scoliosis (AIS) with a minimum follow-up of 10 years, responded to a questionnaire on pain, disability, psychological well-being, health-related quality of life, and general questions about their disease; 81 of the individuals participated in a radiologic and clinical follow-up investigation. Patients with moderate to large curves (≥45°) reported significantly more pain in the Visual Analog Scale. Overall long-term outcome of nonoperatively treated AIS is satisfactory, and no significant compromise of disability and overall quality of life was shown compared with normative values.

From the *Centre for Spinal Surgery, University of Zurich, Balgrist, Zurich, Switzerland; †Department of Psychology, University of Berne, Switzerland; and ‡Department of Psychiatry II, University of Ulm, Bezirkskrankenhaus Gunzburg, Germany.

Acknowledgment date: December 22, 2004. First revision date: April 5, 2005. Acceptance date: April 20, 2005.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Norbert Boos, MD, Centre for Spinal Surgery, University of Zurich, University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.