Long-Term Effects

Scoliosis sufferers may experience a multitude of complications, other than the postural asymmetries that occur, or they may not. Outwardly, the rib prominence scoliosis causes is probably the most common complaint; however, depending on the patient additional complications can occur and are usually the impetus for adults seeking scoliosis treatment, or relief of pain complaints, as time marches on.

Scoliosis may be related to:

  • respiratory dysfunction
  • psychosocial effects due to posture asymmetry
  • pain or discomfort
  • a loss of equilibrium
  • gait abnormalities
  • muscular strength and/or endurance problems

Other complaints patients report with scoliosis are:

  • esophogial problems
  • back pain
  • hip pain
  • knee pain
  • arch/foot pain

The primary and residual effects of scoliosis, when present, are addressed during our scoliosis program. The course of treatment is individualized and takes patient reported complaints into account. Our program focuses on teaching techniques to encourage spinal stabilization for a halted Cobb angle.

Long-term effects of scoliosis have been reported in two well-known studies by Weinstein et al.(1) and Asher & Burton(2). A summary of the conclusions from each is listed below. These studies did not take into account any proactive interventions for scoliosis, such as Schroth Best Practice® curve-pattern-specific exercise.

One of the most interesting takeaways, one which few people are aware of, is Weinstein’s finding that curves held to 30º or less at skeletal maturity will not likely deteriorate (progress) in adulthood. This one finding alone screams for a shift away from the status quo of ‘wait and see’ for curves diagnosed in adolescence. Early interventions for mild scoliosis when there is significant growth potential, and/or a a family history, can and do make a difference. Other findings can’t help but make you wonder, why is surgery for scoliosis so prevalent?

The Natural History of Scoliosis:

(1) Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: A 50 Year Natural History Study. JAMA 2003;289(5):559–567.

Conclusions:

  • “Did not find evidence to link untreated LIS [late-onset adolescent idiopathic scoliosis] with increased rates of mortality in general, or from cardiac or pulmonary conditions potentially related to the curvature.”
  • “Although the prevalence of back pain in untreated scoliosis likely exceeds that in the general population, it does not appear to cause excessive disability.”
  • “Late-onset scoliosis, and possible sequelae such as back pain and pulmonary limitations, must be viewed in light of its effect on function and self-esteem. Patients with idiopathic scoliosis perceive themselves to be less healthy than their peers and experience limitations in certain activities such as lifting, walking long distances, standing and sitting for periods, and the traveling and socializing outside the home.”
  • “Findings…conflict with those of Dickson et al., who found untreated patients to have decreased physical, functional, self-care, and positional abilities when compared with controls.”
  • “Another recently reported follow-up of more than 20 years found no difference in quality of life, including back pain and function, between adolescent idiopathic patients who had undergone surgery and those who remained untreated, as inferred from multiple instruments including the Oswestry Disability, Roland-Morris, and the EuroQol-5D. These studies do not confirm the necessity of intervening in LIS to prevent back pain and disability in late adulthood.”
  • “Curves less than 30° at skeletal maturity rarely get worse.”

(2) Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long-term treatment effects. Scoliosis. 2006;1(1):2

Conclusions:

  • “Compared to controls untreated AIS does not result in an increased mortality rate.”
  • “Most patients with AIS function at or near normal levels, even though pain is more prevalent.”
  • “Surgery, consisting of instrumentation and arthrodesis has virtually eliminated large thoracic curves, although most patients are satisfied with their results, follow-up at 20+ years shows significant, clinically relevant decrease in function and increase in pain compared to controls. Re-operation is required in 6 – 29%.”
  • “Self-image is often slightly diminished. Mental health is usually normal.”
  • “Longer periods of follow-up are needed.”

(3) Danielsson, AJ. Natural history of adolescent idiopathic scoliosis: a tool for guidance in decision of surgery of curves above 50°. J Child Orthop. 2013 Feb;7(1):37-41. Epub 2012 Dec 21.

Conclusions:

  • Most individuals with AIS and moderate curve size around maturity function well and lead an acceptable life in terms of work and family. Some patients with larger curves have pulmonary problems, but not to the extent that this affects the life span. This needs to be taken into account when discussing surgery with the individual patient.