What have studies found regarding the prognosis of idiopathic scoliosis?

Updated: Dec 02, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
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Asher et al performed a retrospective study to determine implant/fusion survivorship without reoperation and the risk factors influencing such survival in 207 patients. Of the 207 patients followed, 19 (9.2%) required reoperation, with 16 of those being for indications related to posterior spine instrumentation. Survival of the implant/fusion without reoperation for spine instrumentation-related indications was 96% at 5 years, 91.6% at 10 years, 87.1% at 15 years, and 73.7% at 16 years. The need for reoperation was significantly influenced by two implant variables: transverse connector design and the lower instrumented vertebra anchors used. [56]

Luhman et al reviewed the prevalence of and indications for reoperations in 1057 spinal fusions for idiopathic scoliosis. Of the 1057 fusions, 41 (3.9%) required reoperation: 11 anterior, 25 posterior, and five circumferential. In addition, 47 other procedures were needed: 20 revision spinal fusions (for pseudarthroses, uninstrumented curve progression, or junctional kyphosis); 16 because of infections (five acute, 11 chronic); seven for implant removal because of pain and/or prominence (four complete, three partial); two (4%) revisions for loosened implants; and two elective thoracoplasties. [57]

Yaszay et al measured the effects of different surgical approaches for adolescent idiopathic scoliosis on pulmonary function over a 2-year period in 61 patients. They evaluated the patients for vital capacity (VC) and peak flow (PF) before surgery and after surgery at 1, 3, 6, 12, and 24 months. They found that scoliosis approaches that penetrated the chest wall resulted in a significant decline in postoperative pulmonary function. Return of pulmonary function did not occur until 3 months after posterior fusion with thoracoplasty; until 3 months after open anterior fusion; and until 1 year after video-assisted thoracoscopic surgery. [58]

After a 10-year follow-up, the data from another study noted that patients who experienced intraoperative chest wall violation during their spinal fusion demonstrated a significant decrease in percent-predicted forced VC and forced expiratory volume in 1 second (FEV1) values. However, those who underwent posterior-only procedures showed significant improvements in forced VC and FEV1 absolute values without any change in percent-predicted values; no changes were noted in percent-predicted values at 5 and 10 years in either group. These results suggest that procedures sparing the chest wall may result in better long-term pulmonary function. [59]

Regarding possible prognostication related to curve progression, Wei-Jun et al suggest that body weight in adolescent males may be an important parameter. Abnormal pubertal growth was noted in idiopathic scoliosis patients compared with healthy controls, with longitudinal growth being similar but body weight being significantly lower in the male adolescent scoliosis subjects. [60]


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