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Natural History, Long-Term Outcomes, And Patient-Centered Evaluation Of Adolescent Idiopathic Scoliosis Across The Lifespan

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Dr. Elena Márquez ¹ ,

⁴ Department of Orthopaedics and Health Outcomes Research, University of Barcelona, Spain

Abstract

Adolescent idiopathic scoliosis (AIS) represents one of the most extensively studied spinal deformities, yet it continues to pose complex clinical, ethical, and methodological challenges across the lifespan. Traditionally defined as a three-dimensional spinal curvature of unknown etiology arising during adolescence, AIS has been investigated through decades of natural history studies, clinical trials, and long-term observational cohorts. The objectives of this research article are threefold: first, to synthesize and critically elaborate on the natural history and progression of AIS from adolescence into adulthood; second, to examine long-term health, functional, and quality-of-life outcomes in untreated, surgically treated, and conservatively managed individuals; and third, to explore the implications of emerging patient-centered outcome frameworks, particularly the concept of the smallest worthwhile effect, for evaluating treatment success in idiopathic scoliosis. Drawing strictly from landmark longitudinal studies, contemporary clinical reviews, and recent conceptual advances in outcome measurement, this article employs a narrative, theory-driven methodology. The findings suggest that while curve magnitude progression and radiographic outcomes remain central to clinical decision-making, they incompletely capture the lived experience of individuals with AIS. Long-term studies demonstrate that many patients with untreated scoliosis maintain acceptable function and health-related quality of life, though subsets experience pain, disability, or psychosocial burden. Surgical intervention, while effective in curve correction, introduces its own spectrum of long-term considerations, including residual pain and functional trade-offs. Integrating patient-centered metrics such as the smallest worthwhile effect offers a more nuanced framework for balancing benefits and harms across diverse treatment pathways. This article concludes that future AIS research and clinical practice must reconcile biomechanical objectives with patient-defined value, advancing toward a lifespan-oriented, individualized model of care.

Keywords

Adolescent idiopathic scoliosis, natural history, long-term outcomes

References

Ansari K, Singh M, McDermott JR, Gregorczyk JA, Balmaceno-Criss M, Daher M, McDonald CL, Diebo BG, Daniels AH. Adolescent idiopathic scoliosis in adulthood. EFORT Open Reviews. 2024.

Curtis DM, Bradley AT, Lin Y, Baker HP, Shi LL, Strelzow JA, et al. National trends show declining use of arthroscopic subacromial decompression without rotator cuff repair. Arthroscopy. 2021.

Erwin J, Carlson BB, Bunch J, Jackson RS, Burton D. Impact of unoperated adolescent idiopathic scoliosis in adulthood: a 10-year analysis. Spine Deformity. 2020.

Ferreira M. Research note: The smallest worthwhile effect of a health intervention. Journal of Physiotherapy. 2018.

Ferreira ML, Herbert RD, Ferreira PH, Latimer J, Ostelo RW, Grotle M, et al. The smallest worthwhile effect of nonsteroidal anti-inflammatory drugs and physiotherapy for chronic low back pain: a benefit–harm trade-off study. Journal of Clinical Epidemiology. 2013.

Finch AR. A patient-centered approach to measuring treatment success: The smallest worthwhile effect as an alternative to the minimal clinically important difference for PROMs in adult idiopathic scoliosis. International Research Journal of Medical Sciences and Health Care. 2025.

Hansford HJ, Jones MD, Cashin AG, Ostelo RW, Chiarotto A, Williams SA, et al. The smallest worthwhile effect on pain intensity of exercise therapy for people with chronic low back pain. Journal of Orthopaedic and Sports Physical Therapy. 2024.

Helenius L, Diarbakerli E, Grauers A, Lastikka M, Oksanen H, Pajulo O, et al. Back pain and quality of life after surgical treatment for adolescent idiopathic scoliosis at five-year follow-up. Journal of Bone and Joint Surgery American Volume. 2019.

Hresko MT. Idiopathic scoliosis in adolescents. New England Journal of Medicine. 2013.

Jada A, Mackel CE, Hwang SW, Samdani AF, Stephen JH, Bennett JT, Baaj AA. Evaluation and management of adolescent idiopathic scoliosis. Neurosurgical Focus. 2017.

Weinstein SL. The natural history of adolescent idiopathic scoliosis. Journal of Pediatric Orthopaedics. 2019.

Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a fifty-year natural history study. JAMA. 2003.

Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. Journal of Bone and Joint Surgery American Volume. 1983.

Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. Journal of Bone and Joint Surgery American Volume. 1981.

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International Research Journal of Medical Sciences and Health Care

Natural History, Long-Term Outcomes, And Patient-Centered Evaluation Of Adolescent Idiopathic Scoliosis Across The Lifespan

Abstract

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