An Evaluation of the Natural History and Outcomes of Congenital Scoliosis

Oregon Health Sciences University, Portland, Oregon; University of Iowa, Iowa City, Iowa, USA

PURPOSE: To evaluate the clinical outcomes and identify factors influencing progression of curvature in patients with congenital scoliosis.

METHODS: The cases of 184 patients with thoracic and lumbar curves seen at the University of Iowa Hospitals & Clinics between 1930 and 1995 were studied. Curves were classified into eight groups consisting of block vertebrae, hemivertebrae-nonincarcerated, hemivertebrae-incarcerated, balanced hemivertebrae, unilateral bar, hemivertebrae with associated bar, wedge vertebrae, and multipleunclassified anomalies. Cobb angle measurements from the earliest and last available anteroposterior radiographs were measured to monitor curve progression.

Clinical outcomes assessing body image and health status were measured using the Body Image Questionnaire for Children (BIQC) and Child Health Questionnaire (CHQ) respectively. The BIQC consists of fourteen positively and negatively worded questions designed to assess perceptions about body size and appearance. The CHQ (Medical Outcomes Trust, Boston, MA) consists of a total of 10 health concept scales regarding health status. For both scales, higher scores are indicative of better clinical outcomes. Means and standard deviations were calculated for radiographic and outcome measures and statistical comparisons made between the different anomaly types.

RESULTS: Patients were followed an average of 7.7 years. Curve progression varied according to the type of anomaly present. The highest annual progression rate was seen in patients having unilateral bars (27.2° annual average) followed by hemivertebrae with associated bar (19°), multipleunclassified anomalies (11.3°), wedge vertebrae (10.7°), nonincarcerated hemivertebrae (10.5°), incarcerated hemivertebrae (9.5°), balanced hemivertebrae (6.0°), and block vertebrae (2.0°).

Hemivertebrae with bar category also had the greatest percentage of patients requiring surgical intervention (87%) and the worst clinical outcomes (average BIQC 53). Patients within this category had the lowest average CHQ scores in six of the ten health concept scales.

CONCLUSIONS: In our study, we found that curve progression rates and clinical outcome measures varied among anomaly types. The most severely progressive curves occurred in patients with hemivertebrae with contralateral bars and those having unilateral bars. Patients with these anomalies had the greatest yearly progression, worst clinical outcomes, and highest incidence of surgical intervention.