Untreated Thoracic Curve in Adult Idiopathic Scoliosis: What Are Patients' Concerns?

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• 作者：Javier Pizones ; MD ; PhD^a ; ^{javierpizones@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Mar Pé ; rez Martin-Buitrago ; MSc^a ; Francisco Javier Sá ; nchez Perez-Grueso ; MD^a ; Ferran Pellisé ; MD ; PhD^b ; Ahmet Alanay ; MD^c ; Ibrahim Obeid ; MD^d ; Frank Kleinstü ; ck ; MD^e ; Emre R. Acaroglu ; MD ; PhD^f ; ESSG European Spine Study Group^g
• 关键词：Untreated scoliosis ; Adult spine deformity ; Adult scoliosis ; Adult thoracic curves ; Untreated thoracic scoliosis
• 刊名：Spine Deformity
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：4
• 期：6
• 页码：439-445
• 全文大小：716 K

文摘

Retrospective two-cohort comparative analysis of data collected prospectively.

Objectives

To analyze a cohort of patients with untreated thoracic curves of an adult multicenter deformity database [European spine study group (ESSG)], describe patient characteristics and concerns, and establish the rate and motivations for surgical intervention.

Summary of Background Data

Idiopathic thoracic curves have a significant clinical and socioeconomic impact during adolescence. However, little attention has been given to adult thoracic scoliosis. The complaints of patients that have reached adulthood with an untreated thoracic curve are still not well studied.

Methods

The database of 1,142 prospective consecutive adult patients with deformity was searched to identify patients with untreated thoracic idiopathic curves: Schwab Type T curves, and Schwab Type D with thoracolumbar/lumbar (TL/L) curves <40° and a difference between main thoracic (MT) and the TL/L ≥15°. Demographic data, different radiologic preoperative parameters, and health-related quality of life questionnaires were assessed.

Results

Forty-two patients met inclusion criteria, showing the following characteristics: age, 30.9 ± 12.5 years; thoracic Cobb, 55.6 ± 10.8°; lumbar Cobb, 28.1 ± 7.3°; sagittal vertical axis, 2.9 ± 19.3 cm; Core Outcome Measures Index (COMI), 4 ± 2.5; Oswestry Disability Index (ODI), 20.4 ± 17.4; Scoliosis Research Society–22 questionnaire (SRS-22) subtotal, 3.6 ± 0.7; 36-Item Short Form Health Survey (SF-36) mental health, 46.1 ± 10.1; SF-36 physical health, 47.3 ± 11.1. Only 13 of these patients underwent surgery. Compared with nonoperated patients, they were younger (24.3 ± 7.3 vs. 33.8 ± 13.4 years; p = .009), had larger MT curves (58.7° ± 9.6 vs. 50.6° ± 8.3; p = .012), and had worse SRS-22 self-image scores (2.9 ± 0.8 vs. 3.5 ± 0.8; p = .042). No patients older than 50 years underwent surgery, despite having worse SRS-22 function (3.0 ± 0.9 vs. 4.1 ± 0.9, p = .032) and worse ODI scores (42.4 ± 19.9 vs. 18.7 ± 18.0, p = .026).

Conclusions

Very few adult deformity patients sought treatment because of untreated thoracic scoliotic curve. The probability of undergoing surgery was low (13/42), and it was associated with youth, curve magnitude, and poor self-image. The rate of surgical treatment of the thoracic curve appears to diminish with age, despite its being associated with poorer function and greater disability in the older patient.