Casper Dragsted

Background and purpose: Treatment of idiopathic scoliosis in childhood aims to prevent curve progression. It is generally accepted that curves > 50° have the highest risk of progression, but less well described is what happens with mild to moderate curves. The aim of this study was to assess long-term curve progression and health-related quality of life (HRQoL) and compare thoracic and thoracolumbar/lumbar (TL/L) curves.Methods: We identified 177 patients diagnosed with a pediatric spinal deformity and treated at our institution from 1972 through 1983. 91 of 129 eligible patients with idiopathic scoliosis completed follow-up (71%). Patient files from treatment/observation in childhood were reviewed including detailed descriptions of radiographs. At follow-up we assessed long standing full-spine radiographs and HRQoL with the Scoliosis Research Society 22 revised questionnaire.Results: Mean follow-up was 41 years (standard deviation [SD] 2.5 years). 21 patients underwent surgery in adolescence or early adulthood leaving 70 patients for analysis of curve progression, of whom 61 had complete radiographs. For patients with a main curve < 25° at the end of treatment in adolescence (n = 19) mean curve progression was 7° (SD 9); for 25–40° curves (n = 26) 16° (SD 13); for 40–50° curves (n =10) 22° (SD 8); and for curves > 50° (n = 6) 17° (SD 6). There was a linear association between main curve size at follow-up and SRS-22r subtotal score (P = 0.003).Conclusion: We found substantial curve progression for patients with main curves > 25° at end of treatment, but with a considerable variation between patients. Curve progression was not associated with curve size at the end of treatment and did not differ significantly between thoracic and TL/L curves. Larger main curve size at follow-up was associated with lower HRQoL.

There is limited knowledge on diffusing capacity in scoliosis patients. It remains to be determined if impaired pulmonary diffusing capacity is mostly influenced by reduced alveolar–capillary membrane diffusing capacity (D_{M, CO}), reduced pulmonary capillary blood volume (V_C) or both. This study aims to report findings from dual test gas pulmonary diffusing capacity for carbon monoxide and nitric oxide (D_{L, CO, NO}) with quantification of pulmonary diffusing capacity for carbon monoxide corrected for haemoglobin with a five s breath‐hold (D_{L, COc, 5s}) and nitric oxide with a five s breath‐hold (D_{L, NO, 5s}), D_{M, CO} and V_C. The study included 57 patients with idiopathic scoliosis seen at our department from 1972 to 1983, all of whom underwent radiological assessment and measurement of D_{L, CO, NO} during examination 40 years after diagnosis. One‐way ANOVA was performed for between‐group differences and Pearson's correlation coefficient was used to assess correlations between D_{L, CO, NO} metrics and Cobb angle. No significant between‐group differences based on disease severity were detected. Thirty‐nine percent of the patients were presented with either reduced D_{L, COc, 5s} or reduced D_{L, NO, 5s} represented as Z‐scores below −1.65. No significant correlations between Cobb angle and Z‐scores for D_{L, COc, 5s}, D_{L, NO, 5s}, D_{M, CO} and V_C according to height measurements were found. When using arm span instead, a weak negative correlation between D_{L, COc, 5s} and Cobb angle (r = −0.29; P = 0.04) was detected. In conclusion, approximately 39% of patients with idiopathic scoliosis had either reduced D_{L, COc, 5s} or reduced D_{L, NO, 5s} 40 years after diagnosis with varying contributions from V_C or D_{M, CO}.

Aims: Only a few studies have investigated the long-term health-related quality of life (HRQoL) in patients with an idiopathic scoliosis. The aim of this study was to investigate the overall HRQoL and employment status of patients with an idiopathic scoliosis 40 years after diagnosis, to compare it with that of the normal population, and to identify possible predictors for a better long-term HRQoL. Methods: We reviewed the full medical records and radiological reports of patients referred to our hospital with a scoliosis of childhood between April 1972 and April 1982. Of 129 eligible patients with a juvenile or adolescent idiopathic scoliosis, 91 took part in the study (71%). They were evaluated with full-spine radiographs and HRQoL questionnaires and compared with normative data. We compared the HRQoL between observation (n = 27), bracing (n = 46), and surgical treatment (n = 18), and between thoracic and thoracolumbar/lumbar (TL/L) curves. Results: The mean time to follow-up was 40.8 years (SD 2.6) and the mean age of patients was 54.0 years (SD 2.7). Of the 91 patients, 86 were female (95%) and 51 had a main thoracic curve (53%). We found a significantly lower HRQoL measured on all the Scoliosis Research Society 22r instrument (SRS-22r) subdomains (p < 0.001) with the exception of mental health, than in an age-matched normal population. Incapacity to work was more prevalent in scoliosis patients (21%) than in the normal population (11%). The median SRS-22r subscore was 4.0 (interquartile range (IQR) 3.3 to 4.4) for TL/L curves and 4.1 (IQR 3.8 to 4.4) for thoracic curves (p = 0.300). We found a significantly lower self-image score for braced (median 3.6 (IQR 3.0 to 4.0)) and surgically treated patients (median 3.6 (IQR 3.2 to 4.3)) than for those treated by observation (median 4.0 (IQR 4.1 to 4.8); p = 0.010), but no statistically significant differences were found for the remaining subdomains. Conclusion: In this long-term follow-up study, we found a significantly decreased HRQoL and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis. Cite this article: Bone Joint J 2023;105-B(2):166–171.

To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine center. Indications for surgery, pre- and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). Sixty-five patients were diagnosed with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre- and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD = 22) and mean EQ-5D time trade-off score was 0.639 (SD = 0.262); this was significantly lower than that in the normal population (p < 0.001). Patients with neurological impairment prior to index surgery had lower EQ-5D scores (p = 0.005) and higher ODI (p = 0.02) at final follow-up compared with patients without neurological impairment. Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.