Surgical vs non-surgical management of adolescent idiopathic scoliosis: a 10-year narrative review of health-related quality of life and radiographic progression in 3315 patients.

Abstract

Objective: To systematically collect, assess, and integrate relevant studies with a follow-up period of at least 10 years to explore the long-term prognosis and influencing factors in patients with adolescent idiopathic scoliosis (AIS).

Methods: A literature search was conducted in PubMed, Embase, The Cochrane Library, Web of Science, Scopus, CNKI, and the Chinese Biomedical Literature Database regarding the long-term prognosis of AIS related to surgical and non-surgical treatments. The search period extended from the inception of each database to July 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies, and relevant data were extracted.

Results: A total of 45 articles were included, covering 3, 315 AIS patients across 15 countries, with the highest number of publications originating from Japan. Most articles were published between 2015 and 2023. Specifically, 30 papers reported on the long-term prognosis of AIS patients who underwent surgical treatment, while 11 articles focused on the long-term prognosis of non-surgical treatments; an additional 4 studies compared the long-term effects of surgical versus non-surgical treatments. Treatment strategies for AIS patients included observation, bracing, exercise therapy, and surgery, with outcome measures primarily focusing on health-related quality of life (HRQoL) and disease progression.

Conclusion: The contemporary therapeutic strategies involving the selection between surgical and non-surgical treatments yields comparable HRQoL and long-term functional outcomes at a follow-up duration exceeding 10 years in both patient cohorts.Surgical treatment has a positive effect on improving long-term prognosis, although some corrective loss is observed, resulting in overall stable outcomes. Non-surgical treatment has limitations in long-term correction effects; however, the HRQoL of patients remains largely unaffected.