Back Pain and Function 22 Years After Brace Treatment for Adolescent Idiopathic Scoliosis- A Follow-Up with a Control Group of Straight Individuals

Introduction: A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age, with brace (BT, n=127; 122 females and 5 males) were followed at least twenty years after completion of the treatment.

Purpose: To determine the long term outcome in terms of back pain and function in patients brace treated for AIS. METHODS: One hundred and nine patients were reexamined as part of an unbiased personal follow-up, including a clinical examination, evaluation of curve size (Cobb method) and degenerative findings in full standing frontal and lateral radiographs, validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms. An age- and sex-matched control group (CTR) of 100 persons was randomly selected and subjected to the same examinations.

Results: Curve size (major curve) was mean 38 degrees (SD 15, 5-71) with a mean increase of 8 degrees from end of treatment to present follow-up. Significantly more patients complained of back pain during the last year (77%) in comparison to the control group (58%, p=0.0012). Pain was located significantly more often in the lumbar (67% of BT vs 47% of CTR) as well as the thoracic region (35% vs 22% repectively), but not in the cervical region. 24% of the patients with pain admitted daily pain but analgesics were sparsely used. A slight but significant difference of the Oswestry Disability Questionnaire as well as scores reflecting general back funtion was found between the patients and controls. No differences could be seen in sociodemographic variables between the groups, except for having been on sick-leave ever due to the back (38% vs 19%, p=0.0036). No correlation could be found between pain and its localization and curve size, increase at least 10° since end of treatment, curve type, degenerative changes on any of the two lowest lumbar disc levels, Body Mass index or smoking.

Discussion and Conclusion: Patients brace treated for adolescent idiopathic scoliosis were found to have approximately the same back function as the general population. A few were physically severely disabled due to the back.