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Health and Function of Patients With Untreated Idiopathic Scoliosis
A 50-Year Natural History Study
Stuart L. Weinstein, MD;
Lori A. Dolan, MA;
Kevin F. Spratt, PhD;
Kirk K. Peterson, MD;
Mark J. Spoonamore, MD;
Ignacio V. Ponseti, MD
JAMA. 2003;289:559-567.
Context 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.
Design, Setting, and Patients 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).
Main Outcome Measures 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° 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.
Author Affiliations: Department of Orthopaedic Surgery, University of Iowa, Iowa City (Drs Weinstein, Dolan, Spratt, and Ponseti), Huxley Family Physicians, Huxley, Iowa (Dr Peterson), and Department of Orthopaedic Surgery, University of Southern California, Los Angeles (Dr Spoonamore).
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