Scoliosis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Complications

• Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace)
• Failure of the bone to join together (very rare in idiopathic scoliosis)
• Low back arthritis and pain as an adult
• Respiratory problems from severe curve
• Spinal cord or nerve damage from surgery or severe, uncorrected curve
• Spine infection after surgery

Prognosis

• The outcome depends on the cause, location, and severity of the curve. The greater the curve, the greater the chance the curve will get worse after growth has stopped.
• The greater the initial curve of the spine, the greater the chance the scoliosis will get worse after growth is complete. Severe scoliosis (curves in the spine greater than 100 degrees) can cause breathing problems.
• Mild cases treated with bracing alone do very well. People with these kinds of conditions tend not to have long-term problems, except an increased rate of low back pain when they get older. People with surgically corrected idiopathic scoliosis can do very well and can lead active, healthy lives.
• Patients with neuromuscular scoliosis have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.
• Babies with congenital scoliosis have a wide variety of underlying birth defects. Management of this disease is difficult and often requires many surgeries.
• The prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are that larger curves carry a higher risk of progression than smaller curves, and that thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, patients who have not yet reached skeletal maturity have a higher likelihood of progression.