Lessons to be learned: best and worst results from a 7 years old clinical database of scoliosis patients

Background and purpose

To verify which patients can reach the best and worst results during conservative treatment, since it is not yet known from previous researches [1, 2].

Material and methods

All scoliosis patients with more than 2 visits included in a prospective clinical database started in September 2003 were reviewed on August 31st 2010. A cut-off of 20 degrees (improvement or worsening) from the first observation was used to select patients. Patients were analysed for diagnosis, morphology, Cobb angle at start, curve improved/worsened, treatment, gender, Body Mass Index, clinical parameters.

Results

Out of 1886 consecutive patients (TP), 62 (3.3%) changed 20° or more: 26 (1.4%) improved (range 20-34°) (IP), 36 (1.9%) progressed (20-60°) (PP).

Females prevailed in IP and low BMI in PP. In PP prevailed juveniles (35% vs 15%-23.8% in IP-TP); conversely, secondary scoliosis prevailed in both PP and IP (25%-15% respectively vs 1.9% in TP). In IP there were only patients who started over 30° Cobb (100%), while in PP 47% started between 10 and 19°; corresponding percentages in TP were 33.9% and 28.5% respectively. Diagnosis of thoracolumbar single curve was the most common in IP (46% vs 22.1% in TP), while double in PP (67% vs 49.8% in TP). Curves improved were thoracolumbar (IP: 58%), worsened thoracic (PP: 78%). Only patients who had a good or optimum treatment improved, but this was true also in 56% of progressed.

Conclusions

Since these results are not similar to what would be expected according to the known natural history, conservative treatment appears able to change it.