title: Radiological Outcomes in Adolescent Idiopathic Scoliosis Patients More Than 22 Years After Treatment.
abstract: METHODS
  Longitudinal cohort.
  
  
  OBJECTIVE
  To evaluate the long-term radiologic outcomes in adolescent idiopathic scoliosis (AIS) patients more than 22 years after treatment.
  
  
  BACKGROUND
  Although treatment for AIS is prophylactic and is aimed at preventing curve progression, very few studies report long-term outcomes of treatment.
  
  
  METHODS
  AIS patients treated with Boston brace or posterior spinal fusion (PSF) with Harrington-dorso-transverse traction (DTT) instrumentation from 1983 to 1990 were requested to return to clinic. Subsequently, 36-inch standing radiographs were obtained after patient consent. Cobb angles were compared with pretreatment and immediate posttreatment radiographs. Any evidence of adjacent-level disease or local kyphosis was also noted.
  
  
  RESULTS
  One hundred fifty-nine (78%) of 219 patients were available for follow-up, 66 braced and 93 surgical. There were 85 females with an average age at surgery of 14.3 years and an average age at follow-up of 37.6 years. The mean length of follow-up was 24.5 years (range, 22-30 years). There was a statistically significant curve progression of 2.9° in the PSF group. There was a greater degree of curve progression in the braced group (5.5°), but this was not statistically significant. Proximal segment degeneration was seen in 8 (5%), 2 in the brace cohort and 6 in the PSF cohort. Distal segment degeneration was seen in 26 (16%) patients, 4 treated with brace and 22 treated with PSF. No patient developed proximal junction kyphosis. Three patients in the PSF cohort required additional surgery for distal adding-on. Four patients had a noncontiguous L5-S1 fusion, three from the PSF cohort and one from the braced cohort.
  
  
  CONCLUSIONS
  In this cohort with an average follow-up of 24.5 years, with 78% available for follow-up, both the braced and surgically treated patients had a very small degree of curve progression, with a small incidence of distal segment degeneration and reoperation.
  
  
  METHODS
  III.
authors.affiliation: Center for Spine Research and Surgery, Lillebaelt Hospital, Ostre Hougvej 55, DK-5500 Middelfart, Denmark. Electronic address: ane.simony1@rsyd.dk.
authors.forename: Ane
authors.initials: A
authors.lastname: Simony
authors.affiliation: Center for Spine Research and Surgery, Lillebaelt Hospital, Ostre Hougvej 55, DK-5500 Middelfart, Denmark; Department of Orthopaedic Surgery, University Hospital - Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
authors.forename: Steen Bach
authors.initials: SB
authors.lastname: Christensen
authors.affiliation: Center for Spine Research and Surgery, Lillebaelt Hospital, Ostre Hougvej 55, DK-5500 Middelfart, Denmark.
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
authors.affiliation: Center for Spine Research and Surgery, Lillebaelt Hospital, Ostre Hougvej 55, DK-5500 Middelfart, Denmark.
authors.forename: Mikkel Osterheden
authors.initials: MO
authors.lastname: Andersen
keywords: Adolescent idiopathic scoliosis; Brace treatment; Harrington-DTT instrumentation; Long-term follow-up; Surgical fusion