Abstract
Natural history of AIS >30° in skeletally mature patients is poorly defined. Studies reporting rates and risk factors for progression are predominantly of large curves in immature patients. Our aim was to determine the rate of curve progression in AIS following skeletal maturity, any associated changes in SRS-22 scores, and identify any potential predictors of curve progression.
Patients enrolled in a prospective, longitudinal, multicentre non-surgical AIS database were evaluated. All patients had minimum 2 year follow-up, idiopathic scoliosis >30°, and were skeletally mature. SRS-22 functional outcome scores and radiographic data were compared at baseline and 2-year follow-up. Patients were divided into 3 groups based on curve size: A=30°-39°, B=40°-49°, C= >50°. Curve progression was defined as any change in curve magnitude.
There were 80 patients, majority females (93.8%) with a mean age of 16.5+/−0.16. Mean BMI was 21+/−0.31 with 15.1% overweight. Mean major cobb at baseline was 38.3°+/−0.88°. At 2 year follow-up 46.3% of curves had progressed an average 3.4°+/−0.38°. Of curves that progressed, patients in group A had the largest mean rate of progression followed by group B. SRS-22 scores on average declined significantly over 2 years in this cohort (4.23 to 4.08; p=0.002). Patients who progressed had on average a more significant decline in SRS outcome scores compared to those that did not (p=0.018, p=0.041 respectively), with the most significant change noted in the Self-Image domain (p=0.03). There was no significant difference in the change in SRS scores over 2 years based on curve size. Univariate analysis did not identify any factors predictive of curve progression in this cohort.
Skeletally mature patients with AIS >30°may continue to have a risk of progression at a mean rate of 1.7°/yr and significant decline in SRS-22 outcome scores, in particular Pain and Self-Image, over time.
