Eduardo Hevia, Jesús Burgos, Vicente García, María Teresa de Santos Moreno, Ibrahim Khalil, Gonzalo Mariscal, Carlos Barrios
{"title":"长期随访显示非手术治疗对中度青少年特发性脊柱侧凸无效:一项综合荟萃分析。","authors":"Eduardo Hevia, Jesús Burgos, Vicente García, María Teresa de Santos Moreno, Ibrahim Khalil, Gonzalo Mariscal, Carlos Barrios","doi":"10.31616/asj.2024.0358","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-term follow-up reveals non-utility of nonsurgical management in moderate adolescent idiopathic scoliosis: a comprehensive meta-analysis.\",\"authors\":\"Eduardo Hevia, Jesús Burgos, Vicente García, María Teresa de Santos Moreno, Ibrahim Khalil, Gonzalo Mariscal, Carlos Barrios\",\"doi\":\"10.31616/asj.2024.0358\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>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.</p>\",\"PeriodicalId\":8555,\"journal\":{\"name\":\"Asian Spine Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Spine Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.31616/asj.2024.0358\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Spine Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31616/asj.2024.0358","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Long-term follow-up reveals non-utility of nonsurgical management in moderate adolescent idiopathic scoliosis: a comprehensive meta-analysis.
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.