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Extreme long-term outcome of operatively versus conservatively treated patients with adolescent idiopathic scoliosis

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Abstract

Purpose

We report on outcomes of surgically versus (vs) non-surgically treated patients with moderate adolescent idiopathic scoliosis (AIS) after minimum of 29 years.

Methods

AIS patients with a follow-up of  ≥ 41 years in the surgical group and  ≥ 29 years in the non-surgical group were included. Patients were treated surgically for primary curves  ≥ 45° vs non-surgically for curves  < 45° or refusal of surgery. Groups were matched for age, gender, comorbidities and primary curve severity. Oswestry Disability Index (ODI) was used to measure clinical outcomes and standard radiography to quantify curve severity at final follow-up.

Results

In total, 16 patients (8 within each group, 75% females) with a median age of 14 (interquartile range (IQR) 2) years could be included and were followed up after 46 (IQR 12) years. All matched variables were similar for both groups, including the primary curve Cobb angles of 48° (IQR 17°) (surgical) vs 40° (IQR 19°) (non-surgical); p = 0.17). At final follow-up after a median of 47 (IQR 5) years for the surgical and 39 (IQR 19) years for the non-surgical group (p = 0.43), the ODI was similar for both groups (15 (IQR 13) points (surgical) vs 7 (IQR 15) points (non-surgical); p = 0.17) with, however, a primary curve magnitude lower in the surgical compared to the non-surgical group (38° (IQR 3°) vs 61° (IQR 33°); p = 0.01), respectively.

Conclusion

After around 47 and 39 years, respectively, surgical and non-surgical treatment of moderate AIS showed similar subjective outcomes, but with a relevant smaller curve magnitude with surgical treatment.

Level of evidence

III

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Acknowledgements

We would like to thank the patients, who participated in this study. Parts of a preliminary abstract were presented as an oral presentation at the annual conference of the Swiss Orthopaedics, Baden, Switzerland, June 26–28, 2019, and annual conference of the Canadian Spine Society (CSS) in Whistler, British Columbia, Canada, from February 26–29, 2020.

Funding

This work was not funded.

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Authors and Affiliations

  1. Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Mazda Farshad, Lucas Kutschke, Christoph J. Laux, Method Kabelitz, Regula Schüpbach, Thomas Böni & Thorsten Jentzsch

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  1. Mazda Farshad
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  2. Lucas Kutschke
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  3. Christoph J. Laux
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  7. Thorsten Jentzsch
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Contributions

MF contributed to the idea, conception, interpretation of data, drafting the manuscript, and supervision of the study. LK, CJL, MK, and RS made contributions to ethics and acquisition of data. TB contributed to the idea, conception, interpretation of data, and supervision. TJ made contributions to the idea, conception, acquisition of data, analysis and interpretation of data, drafting the manuscript, and supervision. All authors contributed to the revision of the manuscript and provided final approval of the version to be published.

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Correspondence to Thorsten Jentzsch.

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The authors declare that they have no conflicts of interest.

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Ethics approval was provided by the local ethics committee (cantonal ethics committee Zurich: 2017-01596).

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Each participant provided an informed consent for participation.

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Each participant provided an informed consent for publication.

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All data analyzed during this study are included in this article.

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Farshad, M., Kutschke, L., Laux, C.J. et al. Extreme long-term outcome of operatively versus conservatively treated patients with adolescent idiopathic scoliosis. Eur Spine J 29, 2084–2090 (2020). https://doi.org/10.1007/s00586-020-06509-1

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  • DOI: https://doi.org/10.1007/s00586-020-06509-1

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