title: Untreated Thoracic Curve in Adult Idiopathic Scoliosis: What Are Patients' Concerns?
abstract: Retrospective two-cohort comparative analysis of data collected prospectively.
  
  
  
  To analyze a cohort of patients with untreated thoracic curves of an adult multicenter deformity database [European spine study group (ESSG)], describe patient characteristics and concerns, and establish the rate and motivations for surgical intervention.
  
  
  
  Idiopathic thoracic curves have a significant clinical and socioeconomic impact during adolescence. However, little attention has been given to adult thoracic scoliosis. The complaints of patients that have reached adulthood with an untreated thoracic curve are still not well studied.
  
  
  
  The database of 1,142 prospective consecutive adult patients with deformity was searched to identify patients with untreated thoracic idiopathic curves: Schwab Type T curves, and Schwab Type D with thoracolumbar/lumbar (TL/L) curves <40° and a difference between main thoracic (MT) and the TL/L ≥15°. Demographic data, different radiologic preoperative parameters, and health-related quality of life questionnaires were assessed.
  
  
  
  Forty-two patients met inclusion criteria, showing the following characteristics: age, 30.9 ± 12.5 years; thoracic Cobb, 55.6 ± 10.8°; lumbar Cobb, 28.1 ± 7.3°; sagittal vertical axis, 2.9 ± 19.3 cm; Core Outcome Measures Index (COMI), 4 ± 2.5; Oswestry Disability Index (ODI), 20.4 ± 17.4; Scoliosis Research Society-22 questionnaire (SRS-22) subtotal, 3.6 ± 0.7; 36-Item Short Form Health Survey (SF-36) mental health, 46.1 ± 10.1; SF-36 physical health, 47.3 ± 11.1. Only 13 of these patients underwent surgery. Compared with nonoperated patients, they were younger (24.3 ± 7.3 vs. 33.8 ± 13.4 years; p = .009), had larger MT curves (58.7° ± 9.6 vs. 50.6° ± 8.3; p = .012), and had worse SRS-22 self-image scores (2.9 ± 0.8 vs. 3.5 ± 0.8; p = .042). No patients older than 50 years underwent surgery, despite having worse SRS-22 function (3.0 ± 0.9 vs. 4.1 ± 0.9, p = .032) and worse ODI scores (42.4 ± 19.9 vs. 18.7 ± 18.0, p = .026).
  
  
  
  Very few adult deformity patients sought treatment because of untreated thoracic scoliotic curve. The probability of undergoing surgery was low (13/42), and it was associated with youth, curve magnitude, and poor self-image. The rate of surgical treatment of the thoracic curve appears to diminish with age, despite its being associated with poorer function and greater disability in the older patient.
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain. Electronic address: javierpizones@gmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Pizones
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Mar Pérez
authors.initials: MP
authors.lastname: Martin-Buitrago
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Sánchez Perez-Grueso
authors.affiliation: Spine Unit, Hospital Universitario Valle Hebrón, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellisé
authors.affiliation: Acibadem University School of Medicine, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alanay
authors.affiliation: CHU Bordeaux Pellegrin Hospital, Bordeaux, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Obeid
authors.affiliation: Department of Orthopaedics, Schulthess Klinik, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Kleinstück
authors.affiliation: Orthopedic Spine, Ankara Spine Center, Ankara, Turkey.
authors.forename: Emre R
authors.initials: ER
authors.lastname: Acaroglu
authors.affiliation: Vall Hebrón Institut de Recerca, Barcelona, Spain.
mesh_terms: D000328:Adult; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications* / Q000601:surgery; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
keywords: Adult scoliosis; Adult spine deformity; Adult thoracic curves; Untreated scoliosis; Untreated thoracic scoliosis