Long-term follow-up of fused and unfused idiopathic scoliosis

Abstract

We reviewed 77 unfused and 91 fused patients with idiopathic scoliosis who first attended between 1949 and 1965. Both groups were re-examined at least 10 years after reaching skeletal maturity, with attention to progression of the Cobb angle, increased in vertebral rotation, back pain and psychosocial problems. We found that spinal fusion protects the scoliotic spine from further deterioration during adult life except for those with severe curves and marked rotation. Fusion also significantly reduced the incidence of severe pain and allowed patients to carry out heavy physical work, but did not confer complete immunity from backache. Surgery improved the appearance, but patients were not always completely satisfied with the cosmetic result.

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

“…Within the literature, however, there is no extensive investigation of whether this treatment has a significant impact on the cervical spine above or the lumbar spine below. In particular, studies evaluating the effects of scoliosis surgery on cervical spine sagittal alignment are scarce and it is not clear if scoliotic patients treated with surgery have a greater incidence of neck pain as compared to normal subjects [13]. Recent publications have shown a correlation between cervical kyphosis and axial neck pain or new-onset neurologic symptoms [14][15][16].…”

“…Recent publications have shown a correlation between cervical kyphosis and axial neck pain or new-onset neurologic symptoms [14][15][16]. In particular, Edgar and Metha [13], in their long-term follow-up of fused and unfused idiopathic scoliosis patients, found an incidence of cervicodorsal pain in 17.6% of the patients who had undergone fusion and 7.8% of the patients who had not.…”

“…In particular, the Cotrel-Dubousset technique restores thoracic kyphosis for patients with hypokyphotic spines and preserves or restores normal lumbar lordosis in a considerable percentage of patients [10][11][12]. Studies evaluating the effects of scoliosis surgery on cervical spine sagittal alignment are scarce and it is possible that scoliotic patients treated with surgery have a greater incidence of cervicodorsal pain when compared with normal subjects [13]. Recent publications have shown correlations between cervical kyphosis and axial neck pain, and between the loss of thoracic kyphosis and the development of cervical kyphosis in pre-operative radiographs of patients with adolescent idiopathic scoliosis [14][15][16][17].…”

Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery

“…Psychological well-being has previously been shown to be influenced by the scoliosis and the appearance of the curve itself [17,21]. The treatment per se may also impact on the quality of life and psychological well-being in a negative way [19,33,35,37].…”

“…New questionnaires have been developed [2,7,29] and are currently being evaluated [29]. A number of previous studies have discussed quality of life (QL) in general terms [12,17,21,34]. So far, only a few studies using modern, validated questionnaires have been published.…”