Natural history

A major problem frustrating our understanding of the natural history of adolescent idiopathic scoliosis is the relatively small numbers in the studies throughout the literature. Moreover, these studies are strongly weighted towards females and thoracic curves. Most studies are retrospective and many cases are lost to follow-up. Many factors militate against adequate follow-up, including societal mobility and current health care delivery schemes. Natural history most importantly addresses curve progression, while pulmonary function, mortality, psychosocial effects, pain, and pregnancy issues, more concern the severe deformity. At what point is late onset idiopathic scoliosis important as a health care issue? We need much more good quality data on natural history to try and answer these questions. Existing studies may have limitations, but for the above mentioned reasons may have to suffice. We do not know who is going to suffer adverse consequences from their scoliosis, and the likelihood of obtaining more meaningful data is daunting. We know that only a small fraction of our total patient population derives benefit from therapy and perhaps we are already overtreating this group. Those centers not describing nonoperative treatment may be able to contribute impartial information on natural history.