Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.
BACKGROUND
Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history.


OBJECTIVE
To present the outcomes related to health and function in untreated patients with LIS.


METHODS
Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years).


METHODS
Mortality, back pain, pulmonary symptoms, general function, depression, and body image.


RESULTS
The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain.


CONCLUSIONS
Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.
Weinstein
Stuart L
SL
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. stuart-weinstein@uiowa.edu
Dolan
Lori A
LA
Spratt
Kevin F
KF
Peterson
Kirk K
KK
Spoonamore
Mark J
MJ
Ponseti
Ignacio V
IV
D000203:Activities of Daily Living; D000368:Aged; D001416:Back Pain / Q000209:etiology; D001828:Body Image; D002423:Cause of Death; D003863:Depression / Q000209:etiology; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012600:Scoliosis / Q000401:mortality / Q000523:psychology; D012720:Severity of Illness Index