Scoliosis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]
Overview
The literature on the natural history of untreated scoliosis is fairly limited. With curve progression, it can have effects on socioeconomic and marital status, increased disability due to back pain and late complications like pulmonary hypertension and cor pulmonale. The prognosis of scoliosis depends on the likelihood of curve progression. The general dictum 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. Moreover, patients who have not yet reached skeletal maturity have a higher likelihood of progression.
Natural History
- The literature on the natural history of untreated Adolescent Idiopathic Scoliosis is fairly limited.[1][2]
- Past studies revealed a grim prognosis,1-3 mostly as a result of socioeconomic effects on work and marital status, the development of cor pulmonale, and increased disability secondary to back pain.
- The major threat, though, is how the pulmonary function is affected over time.[3][4][5][1]
- Pulmonary function is considered to be at its peak around the age of 20 years or just after, and a slow deterioration begins thereafter as part of the aging process.[5][1]
- If left untreated, an increase of the curve size further adds to the reduction of the pulmonary function.
- Thus,radiographs have to be performed at regular follow-up while observing for curve progression.
Complications
- Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace)
- Pseudoarthrosis (very rare in idiopathic scoliosis)[5]
- Low back arthritis and pain as an adult[5]
- Respiratory problems from severe curve with significant decline in pulmonary function leading to pulmonary hypertension and cor pulmonale[5]
- Spinal cord or nerve damage from surgery or severe, uncorrected curve
- Spine infection after surgery
- Intracranial hemorrhage following surgery[6]
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 80 degrees) with early onset can cause cardio-pulmonary problems such as loss of vital capacity, pulmonary hypertension, and cor pulmonale, especially with thoracic curves.[5]
- The mortality rate increased 2.2 times in all patients with idiopathic scoliosis and 3.2 times for patients above 45 years of age.[5]
- Mild cases treated with bracing alone do very well. People with these kinds of conditions do not tend to have long-term problems, except an increased rate of low back pain when they get older.This leads to poor quality of life.
- 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.
- In addition, the patients are usually self-conscious or depressed about their body shape.
- 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.
References
- ↑ 1.0 1.1 1.2 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMC 5922622. PMID 10.1007/978-4-431-56541-3_2 Check
|pmid=value (help). - ↑ Machida, Masafumi (2018). Pathogenesis of idiopathic scoliosis. Tokyo, Japan: Springer. ISBN 978-4-431-56539-0.
- ↑ Wong HK, Tan KJ (2010). "The natural history of adolescent idiopathic scoliosis". Indian J Orthop. 44 (1): 9–13. doi:10.4103/0019-5413.58601. PMC 2822427. PMID 20165671.
- ↑ "Reorganized text". JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Danielsson AJ (2013). "Natural history of adolescent idiopathic scoliosis: a tool for guidance in decision of surgery of curves above 50°". J Child Orthop. 7 (1): 37–41. doi:10.1007/s11832-012-0462-7. PMC 3566251. PMID 24432057.
- ↑ Bhimani R, Bhimani F, Singh P (2018). "Subdural Hemorrhage after Scoliosis and Detethering of Cord Surgery". Case Rep Med. 2018: 5061898. doi:10.1155/2018/5061898. PMC 5902091. PMID 29808094.