A research team conducted a systematic review and meta-analysis to evaluate the outcomes of conservative management of moderate adolescent idiopathic scoliosis (AIS), focusing on long-term curve behavior, surgical rates, patient-reported outcomes, and the influence of follow-up duration.
They conducted a comprehensive literature search adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Statistical analyses, encompassed mean differences, risk ratios, pooled incidences, and random-effects models. Heterogeneity was assessed using the I2 statistic.
The outcome measures were radiographic curve progression, percentage of patients with significant progression (greater than 5 degrees), surgery rates, sagittal profile changes, back pain rates, quality of life scales, and functional outcomes.
Thirteen studies involving 1,492 patients with AIS curves within 30-45 degrees, treated conservatively, with a minimum ten-year follow-up were included.
At 20-plus years of follow-up (mean age 34.5 years), curves worsened by an average of -5.69 degrees. At 25-plus years of follow-up (mean age 49.8 years), curves worsened by an average of -14.32 degrees.
The incidence of significant progression was 35.68 percent. The surgery rate was 14.20 percent. Sagittal alignment (thoracic kyphosis and lumbar lordosis) remained within normal ranges at the final follow-up, with no significant changes from baseline. The back pain rate was 63.35 percent.
“These findings highlight the alarming incidence of curve progression and pain in conservatively managed AIS patients,” according to the authors. “A critical reevaluation of conservative versus operative indications is imperative to mitigate long-term impacts and improve outcomes for this population.”
The study, “Long-term follow-up reveals non-utility of nonsurgical management in moderate adolescent idiopathic scoliosis: A comprehensive meta-analysis,” was published in the Asian Spine Journal.
