Elsevier

Spine Deformity

Volume 4, Issue 6, November 2016, Pages 439-445
Spine Deformity

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

https://doi.org/10.1016/j.jspd.2016.05.004Get rights and content

Abstract

Study Design

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.

Introduction

Idiopathic thoracic curves have a significant clinical and socioeconomic impact during adolescence. Adolescent idiopathic scoliosis patients exhibit a higher prevalence of thoracic (Lenke Type 1 and 2 curves) than lumbar scoliosis [1], [2] especially those with bigger curves requiring surgical treatment [3], [4], [5]. If left untreated, thoracic curves with Cobb angles greater than 50° progress the most after skeletal maturity [6], [7], [8], [9], [10], and with Cobb angles higher than 80° can induce shortness of breath [8], [10], [11] and cause restrictive pulmonary disease [12], [13], [14]. Surgery is therefore recommended in patients with idiopathic thoracic progressive curves greater than 50° to try to avoid these potential consequences [7], [15], [16].

On the contrary, adult deformity literature, which is nowadays in the spotlight, is basically centered on thoracolumbar deformity, mainly because these curves become symptomatic in adulthood. Lumbar curves progress as disc degeneration appears, decreasing quality of life and function in adulthood [17], and surgical treatment has demonstrated to significantly improve patient's quality of life [18], [19], [20]. However, little attention has been given to adult thoracic scoliosis. The complaints of patients who have reached adulthood with an untreated thoracic curve are still not well studied. The few available long-term follow-up studies mix thoracic with lumbar and with double or triple curves, reporting that, in general, untreated scoliosis can produce functional impairment, psychologic disturbances [6], [7], [10], chronic back pain [8], [11], [12], [21], and can influence self-image even 50 years after the initial diagnosis [11].

However, we could not find any literature reporting the behavior of only pure thoracic untreated curves. There is no transversal study that can provide a picture of the amount of untreated thoracic patients who seek consultation because of their deformity, the concerns that these patient present in adulthood, or the motivations to undergo surgery. These data are difficult to find without a historical cohort or a big updated database.

The aim of this study was to analyze the cohort of patients with untreated thoracic curves of an adult multicenter deformity database, describe patient characteristics and concerns, and establish the rate and motivations for surgical intervention.

Section snippets

Material and Methods

We conducted a retrospective analysis of data collected prospectively in an adult multicenter deformity database, the European spine study group (ESSG) that includes patients ≥18 years of age, having a coronal spinal curvature ≥20° or sagittal vertical axis >5 cm, or a pelvic tilt >25° or thoracic kyphosis >60°.

From all of the consecutively enrolled adult patients on the database, we searched to identify patients with untreated main thoracic idiopathic curves, defined as follows: Schwab Type T

Results

From October 2010 till January 2015, 1,142 patients were registered in our Adult Spine Deformity (ESSG) database. From those, 692 consulted for previously untreated scoliosis. Among these 692, a total of 42 patients fulfilled our inclusion criteria (of pure untreated thoracic deformity). The majority of these patients were younger than 30 years of age; however, there was a small subsample of patients older than 50 years.

Detailed characteristics (demographic, radiologic, and quality of life

Discussion

The prevalence of thoracic idiopathic scoliosis in adolescents is higher than that of double, triple, and lumbar only curves [1], [2]. The reported prevalence of mild thoracic scoliosis in patients consulting for respiratory symptoms older than 50 years is 24.2% [22]; however, no study has evaluated its prevalence in the adult general population.

The rate of surgery due to a thoracic curve during the adolescent period is high, reaching 56%–71% of all AIS surgeries [3], [4], [5]. This is based in

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  • Cited by (6)

    Author disclosures: JP (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study; personal fees from Jonson and Johnson Depuy-Synthes Spine, personal fees from Medtronic, personal fees from Alphatec Spine, outside the submitted work), MPMB (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study), FJSPG (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study; personal fees from Depuy-Synthes Spine, personal fees from K2M, outside the submitted work), FP (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study; personal fees from Depuy-Synthes Spine, personal fees from K2M, personal fees from Biomet, outside the submitted work), AA (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study; personal fees from Depuy-Synthes Spine, personal fees from Stryker, outside the submitted work), IO (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study; personal fees from Depuy-Synthes Spine, personal fees from Medtronic, outside the submitted work), FK (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study), ERA (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study; grants from Spine Society of Europe, grants from Medtronic, personal fees from AOSpine, personal fees from IncredX, outside the submitted work), ESSG (grants from Johnson and Johnson Depuy-Synthes Spine, during the conduct of the study; grants from Johnson and Johnson Depuy-Synthes Spine, outside the submitted work).

    The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

    A Johnson and Johnson Depuy-Synthes Spine research grant was received in partial support of this work.

    No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

    This study has IRB / research ethics committee approval.

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