Scoliosis Outlook Not So Grim

Most With Untreated Spine Curve Suffer Few Problems

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Feb. 5, 2003 -- Most adults with untreated curvature of the spine do just fine. That's the finding of an extraordinary 50-year study of people with scoliosis.

Not all scoliosis is the same. The most common form is called late-onset idiopathic scoliosis. It's a curving of the spine that for no apparent reason strikes otherwise healthy children after age 10. But there are other, less common forms that can be much more severe.

You get a grim picture if you lump all types of scoliosis together. That's why doctors once thought -- and why many people still believe -- that scoliosis inevitably leads to a twisted body, crippling back pain, and damage to the lungs and heart. To get a better picture, Stuart L. Weinstein, MD, led a University of Iowa team that looked at 117 untreated scoliosis patients diagnosed as long ago as 1932. They report their findings in the Feb. 5 issue of TheJournal of the American Medical Association.

"By closely studying this group of patients for more than 50 years, we have learned that patients with untreated late-onset scoliosis can function well as young adults, become employed, get married, have children, and grow to become active older adults," Weinstein and colleagues write. "Unfortunately, patients with untreated late-onset scoliosis can develop significant deformity, and the cosmetic aspect of this condition can not be disregarded."

This "cosmetic aspect" is a slow-but-sure curving of the back that gets worse with age. It does cause back pain, but few of the patients in the study needed narcotic painkillers to control their pain. Indeed, the scoliosis patients in the study reported little more back pain than did a similar group of people who did not have scoliosis. Moreover, scoliosis did not cut their lives short or lead to early disability.

Depending on the severity of the condition, some adolescents may need back braces while their bones mature. However, some doctors question this treatment. Some adolescents and adults with scoliosis may need -- or want -- spinal-fusion surgery to prevent further curving.

In an editorial accompanying the Weinstein report, Paul D. Sponseller, MD, of Johns Hopkins University, writes that adult scoliosis varies widely from patient to patient. Surgery to correct further spinal curvature has its own problems, he notes, although it has a low complication rate. He praises the study for giving doctors and their patients an honest look at what's likely to happen if late-onset scoliosis isn't treated.

"Since bracing and surgery are not problem free, patients can be counseled to match treatment to their preferences," Sponseller writes.

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SOURCES: The Journal of the American Medical Association, Feb. 5, 2003.
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