Long-Term Clinical Outcomes of Surgery for Adolescent Idiopathic Scoliosis 21 to 41 Years Later

Study Design. A case control study. Objective. To determine the clinical outcome of middle-aged patients surgically treated for adolescent idiopathic scoliosis and to compare their outcomes with assessments of age- and sex-matched healthy controls. Summary of Background Data. Several long-term follow-up studies have been published on the clinical outcomes of surgical treatment for adolescent idiopathic scoliosis in patients who have reached their 20s or 30s. However, clinical outcomes in patients who have reached middle age remain unknown. Methods. This study included 256 patients surgically treated for adolescent idiopathic scoliosis (AIS) between 1968 and 1988. The Scoliosis Research Society Patient Questionnaire (SRS-22) and Roland-Morris Disability Questionnaire (RDQ) were used for evaluating long-term clinical outcomes. Sixty-six (25.8%; 62 females, 4 males; mean age, 46.0 years [range 34-56]) of the 256 patients responded to the questionnaires. The mean follow-up period was 31.5 (range 21-41) years. Seventy-six healthy age- and sex-matched individuals with neither a history of spinal surgery nor scoliosis were selected as a control (CTR) group. Results. On the basis of the SRS-22 responses, AIS patients had significantly decreased function (AIS: 4.3 +/- 0.6, CTR: 4.7 +/- 0.5, P < 0.01) and decreased self-image (AIS: 3.0 +/- 0.8, CTR: 3.7 +/- 0.5, P < 0.01) in comparison with the controls, but the 2 groups were similar with respect to pain (AIS: 4.3 +/- 0.6, CTR: 4.2 +/- 0.5, P = 0.14) and mental health (AIS: 3.9 +/- 0.9, CTR: 3.7 +/- 0.7, P = 0.14). The RDQ responses indicated that low back pain was not significantly increased in the AIS group compared with the CTR group (AIS: 1.8 +/- 3.5, CTR: 1.4 +/- 3.1, P = 0.36). Conclusion. Surgery had no demonstrable adverse effects on pain or mental health in these middle-aged AIS patients 21-41 years after surgery, although the AIS patients did have significantly lower function and lower self-image than the controls.