Long-term follow-up reveals non-utility of nonsurgical management in moderate adolescent idiopathic scoliosis: a comprehensive meta-analysis

Abstract

This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management of moderate adolescent idiopathic scoliosis (AIS), focusing on long-term curve behavior, surgical rates, patient-reported outcomes, and the influence of follow-up duration. A comprehensive literature search was conducted adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Statistical analyses, using Review Manager, encompassed mean differences, risk ratios, pooled incidences, and random-effects models. Heterogeneity was assessed using the I2 statistic. The outcome measures were radiographic curve progression, percentage of patients with significant (>5°) progression, surgery rates, sagittal profile changes, back pain rates, quality of life scales, and functional outcomes. Thirteen studies involving 1,492 patients with AIS curves within 30°-45°, treated conservatively, with a minimum 10-year follow-up, were included. At 20+ years of follow-up (mean age, 34.5 years), curves worsened by an average of -5.69° (95% confidence interval [CI], -11.66 to 0.29). At 25+ years of follow-up (mean age, 49.8 years), curves worsened by an average of -14.32° (95% CI, -20.14 to -8.50). The incidence of significant progression was 35.68% (95% CI, 22.85 to 48.50). The surgery rate was 14.20% (95% CI, 0.87 to 27.53). Sagittal alignment (thoracic kyphosis and lumbar lordosis) remained within normal ranges at the final follow-up, with no significant changes from baseline. Back pain rate was 63.35% (95% CI, 38.36 to 88.34). These findings highlight the alarming incidence of curve progression and pain in conservatively managed AIS patients. A critical re-evaluation of conservative versus operative indications is imperative to mitigate long-term impacts and improve outcomes for this population.