Deformity

Natural History of Progressive Adult Scoliosis

Marty-Poumarat, Catherine MD^*; Scattin, Luciana MD^†; Marpeau, Michèle MD^*; Garreau de Loubresse, Christian MD^‡; Aegerter, Philippe MD, PhD^§

Author Information

From the *Department of Neuroorthopaedic and Adult and Children Scoliosis, R. Poincaré Hospital, Garches, France; †“La Nostra Famiglia” I.R.C.C.S e Medea, Conegliano (TV), Italy; ‡Department of Orthopaedic Surgery, R. Poincaré Hospital, Garches, France; and §Clinical Research Unit, Statistics and Epidemiology Department, A. Paré Hospital, Assistance Publique Hopitaux de Paris, Boulogne, France.

Acknowledgment date: November 16, 2005. First revision date: February 17, 2006. Second revision date: April 21, 2006. Third revision date: June 20, 2006. Fourth revision date: August 24, 2006. Fifth revision date: September 5, 2006. Sixth revision date: October 10, 2006. Acceptance date: October 11, 2006.

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 Catherine Marty-Poumarat, MD, Department of Neuroorthopaedic and Adult and Children Scoliosis, R. Poincaré Hospital, Avenue Raymond Poincare, Hauts de Seine, 92380 Garches, France; E-mail: [email protected]

Spine 32(11):p 1227-1234, May 15, 2007. | DOI: 10.1097/01.brs.0000263328.89135.a6

Study Design.

A retrospective analysis of the progression of adult scoliosis.

Objective.

To establish an individual prognosis.

Summary of Background Data.

Most studies have investigated the adolescent scoliosis after skeletal maturity, but the results are discordant.

Methods.

Two senior physicians measured all the radiographs of 51 adults who had a progressive scoliosis. The mean delay between the first and last radiograph was 27 years. For each patient, a diagram was established with the Cobb angle on the y-axis and the corresponding age on the x-axis. We noted the age and Cobb angle of the first radiograph showing a rotatory subluxation and the age of menopause. We used linear regression and the analysis of variance test.

Results.

The mean number of radiographs per patient was 6. The linear test was significant in 46 patients. Two main types exist. Type A is an adolescent scoliosis that continues to progress after skeletal maturity, whereas type B appears or progresses late. There were 13 type A and 20 type B of which 11 progressed around menopause. Significant differences were noted between groups A and B regarding loss of body height (group A, 5 cm and group B, 9.5 cm; P < 0.001), rate of progression in lumbar single and thoracolumbar single curves (group A, 0.82°/y and group B, 1.64°/y; P < 0.004), Cobb first radiograph (group A, 37° and group B, 20°; P < 0.0001), age rotatory subluxation (group A, 42 years and group B, 56 years; P < 0.0001), and Cobb rotatory subluxation (group A, 52° and group B, 29°; P < 0.0001).

Conclusions.

The originality of our study is the diagram. We demonstrated that the rate of progression was linear, and it can be used to establish an individual prognosis. The diagrams visualized 2 main distinct types. There was a significantly faster rate of progression in type B. In type A, rotary subluxation occurs during progression of the curvature. In type B, it seems to be the initial event. Menopause is a period of deterioration in type B.

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