Long-term outcomes of adolescent idiopathic scoliosis: Natural history of untreated, braced, surgically treated patients in adult life

Table 1 Long-term outcomes of untreated adolescent idiopathic scoliosis

Ref.	Type of study	Sample size and follow-up	Curve range (°)	Outcomes	Findings
Weinstein et al[12], 2003	Prospective longitudinal cohort study	117 patients, 50-year follow-up	Mean 60°	Function, pain, HRQoL	Most patients led normal lives with only mild functional limitation. Back pain common but not disabling
Danielsson et al[6], 2010	Retrospective comparative cohort study	109 patients, approximately 22 years	> 45° (untreated vs braced)	HRQoL, pain, self-image	No significant HRQoL difference between braced and untreated patients
Farshad et al[19], 2022	Retrospective cohort study	64 patients, 42-year follow-up	Mean progression approximately 20°	Curve progression, PROMs	Minimal difference in function between observed and braced patients
Brandwijk et al[20], 2023	Cross-sectional long-term follow-up study	60 patients, 30-year follow-up	> 45°	ODI, Short-Form 36	79% minimal disability; pain increased but not clinically disabling
Ascani et al[21], 1986	Retrospective longitudinal cohort study	88 patients, 33 years	30°-80°	Curve progression, disability	Larger curves progressed more, but retained independence and functionality
Ohashi et al[18], 2018	Retrospective longitudinal cohort study	54 patients, 25-year follow-up	Thoracolumbar/Lumbar	Back pain, curve progression	Moderate increase in back pain with progressive curve
Hassan and Bjerkreim[16], 1983	Retrospective cohort study	84 patients, 30-year follow-up	60°-80°	Curve progression rate	Rapid curve progression in adolescence (approximately 3°/year), slowed in adulthood (approximately 1°/year)
Pehrsson et al[26], 1992	Retrospective cohort study	130 patients, 39-year follow-up	Mean 70°	Mortality, pulmonary function	No excess mortality in idiopathic scoliosis; pulmonary compromise mostly in curves > 100°
Rushton and Grevitt[24], 2013	Systematic review and meta-analysis	Meta-analysis (21 cohorts)	Mixed	HRQoL, pain, self-image	Self-image impaired; function and pain largely preserved
Gremeaux et al[22], 2009	Cross-sectional long-term follow-up study	38 women, > 30 years	Various	Spinal height loss, disability	Greater spinal height loss with age; limited functional impact
Danielsson and Hallerman[30], 2015	Retrospective case series	Middle-aged patients, > 30 years	Not reported (early onset)	Self-image, function	Quality of life generally preserved; body image remained a concern in some
Danielsson and Nachemson[59], 2001	Retrospective matched case-control	Women, 22-year follow-up	Approximately 50°	Pregnancy outcomes, pain	Normal fertility and pregnancy outcomes
Nachemson[27], 1968	Retrospective cohort	Unknown (early study)	> 100°	Mortality, disability	Increased mortality noted, but likely due to inclusion of non-idiopathic scoliosis
Collis and Ponseti[31], 1969	Retrospective cohort	Long-term cohort	Various	Long-term function	No significantly impaired function or life expectancy
Agabegi et al[35], 2015	Systematic review	Not reported	Various	Risk factors, progression	Identify key predictors of progression in untreated cases
Luo et al[17], 2025	Systematic review and meta-analysis	Not reported	Various	Radiographic predictors	Curve pattern, flexibility, and apex location affect progression
Gremeaux et al[34], 2008	Cross-sectional analysis	Adults with scoliosis	Various	Back pain	Back pain increased but not disabling

HRQoL: Health-related quality of life; PROM: Patient-reported outcome measure; ODI: Oswestry Disability Index; AIS: Adolescent idiopathic scoliosis.

Table 2 Long-term outcomes of bracing in adolescent idiopathic scoliosis

Ref.	Study type	Sample size and follow-up	Curve range (°)	Outcomes	Key findings
Weinstein et al[7], 2013	Randomized controlled trial	242 patients, mean 3.4 years	Not specified	Curve progression (≥ 50°)	72% braced avoided progression ≥ 50° vs 48% in observation group
Danielsson et al[6], 2010	Retrospective comparative cohort	109 patients, mean 22 years	> 45° (braced vs untreated)	HRQoL, curve stability	No significant HRQoL difference; better curve stability in braced group
Dolan and Weinstein[3], 2007	Narrative review	Review of long-term data (20+ years)	Not specified	Surgical rates	Bracing reduced surgical rates in compliant patients
Donzelli et al[44], 2023	Prospective cohort study	1067 patients, end of treatment	Not specified	In-brace correction, treatment success	High in-brace correction and compliance predicted bracing success
Simony et al[42], 2015	Retrospective long-term cohort	117 patients, 25-year follow-up	Not specified	HRQoL, function	HRQoL similar to general population; good physical function
Capek et al[46], 2023	Prospective comparative study	358 patients, mean 5-7 years	> 30°	Bracing regimen efficacy	Full-time bracing more effective for curves > 30°
Danielsson[25], 2007	Retrospective cohort study	106 patients, 16-year follow-up	Not specified	Curve stability, QoL	Stable curves; QoL similar to surgically treated patients
Negrini et al[50], 2015	Systematic review	Cochrane review of multiple studies	Various	Bracing effectiveness	Bracing effective if worn ≥ 18 hours/day
Negrini et al[40], 2018	International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment guideline and expert opinion	Expert consensus (guidelines)	25°-40°	Bracing indications, standards	Guidelines standardized indications, compliance, and in-brace correction goals
van den Bogaart et al[45], 2019	Best evidence synthesis	Review and synthesis of 13 studies	20°-45°	Predictors of success	High in-brace correction and early initiation are strongest predictors
Karol et al[41], 2016	Prospective observational study	Not specified	Not specified	Compliance, brace outcome	Counseling improved brace wear time and outcomes
Danielsson et al[43], 2001	Retrospective case-control study	Long-term, 20+ years	Not specified	Brace vs surgical outcomes	No major differences in long-term function or satisfaction
Karavidas[49], 2019	Review article	Narrative summary	Not specified	Evidence summary	Emphasized timing, compliance, and psychological support for optimal results
Costa et al[62], 2021	Systematic review/meta-analysis	18 studies included	Various	Bracing concepts and outcomes	Rigid braces more effective than soft; compliance critical
Swaby et al[47], 2023	Prospective RCT protocol	Protocol; ongoing Bracing Adolescent Idiopathic Scoliosis study	25°-40°	Night time vs full-time bracing	Ongoing trial comparing both
Aulisa et al[48], 2014	Prospective cohort	113 juvenile idiopathic scoliosis patients, mean follow-up 6 years	≥ 25°	Juvenile idiopathic scoliosis bracing efficacy	84% success rate in avoiding progression > 45°; high compliance linked to success
Danielsson et al[43], 2001	Matched follow-up study	Long-term (20+ years)	Not specified	HRQoL post-treatment	Braced patients had similar QoL as surgical group and healthy controls

HRQoL: Health-related quality of life; QoL: Quality of life; RCT: Randomised controlled trial.

Table 3 Long-term outcomes of surgical treatment in adolescent idiopathic scoliosis

Ref.	Type of study	Sample size and follow-up	Curve range (°)	Outcomes	Key findings
Danielsson et al[43], 2001	Matched follow-up study	22 years	> 45°	HRQoL, function, radiographs	Surgical group: Similar HRQoL as controls; good cosmetic outcomes
Danielsson[25], 2007	Retrospective cohort	16 years	> 45°	Curve stability, function	Long-term curve stability and patient satisfaction
Danielsson et al[6], 2010	Comparative retrospective cohort	22 years	> 45°	HRQoL, self-image	Surgery improved self-image over bracing
Danielsson and Hallerman[30], 2015	Long-term case series	Long-term	Early-onset > 50°	QoL	Surgical correction preserved function and self-perception
Zhu et al[9], 2017	Matched cohort study	160 patients	> 50°	Radiographic + functional outcomes	Early AIS surgery had better biomechanical and safety outcomes
Larson et al[55], 2019	Prospective cohort	≥ 20 years	> 50°	HRQoL, surgical durability	High satisfaction, stable correction maintained
Reames et al[51], 2011	Multicenter database review	19360 surgeries	Mixed AIS	Complication rates	5%-10% complication rate; serious complications < 1%
Roberts and Tsirikos[56], 2022	Surgical review	Not reported	Mixed AIS	Complication management	Management strategies for surgical complications
Weinstein et al[7], 2013	Randomised controlled trial cohort (BrAIST surgical arm)	Mean 2 years	> 50°	Cobb progression, SRS-22	Early surgery prevented severe progression; high satisfaction
Dolan and Weinstein[3], 2007	Narrative review	> 20 years	> 50°	Surgical rates, satisfaction	Long-term benefit in curve stabilization; patient satisfaction
Trobisch et al[57], 2010	Review	Not reported	> 50°	Summary of surgical outcomes	Modern surgery shows reliable correction and low morbidity
Pishnamaz et al[33], 2024	Literature review	20-30 years	> 50°	Meta-analysis of surgical results	Long-term surgery: Stable curves and improved QoL
Weiss et al[15], 2003	Review	Not reported	Mixed	Mortality, morbidity	AIS alone not associated with increased mortality
Westrick and Ward[58], 2011	Systematic review	5-20 years follow-up	> 50°	Evidence-based surgical results	Surgery provides reliable long-term results in AIS
Tsirikos and García-Martínez[60], 2023	Cross-sectional long-term follow-up study	265 patients; mean follow-up 10-25 years (≥ 10 years)	Mixed pediatric deformities including AIS	HRQoL (SRS-22, Short-Form 36), pain, general health	Sustained improvements in HRQoL and pain comparable to general population. Postoperative scores were similar to those of age-matched controls, including the AIS subgroup

HRQoL: Health-related quality of life; QoL: Quality of life; AIS: Adolescent idiopathic scoliosis; SRS: Scoliosis Research Society; BrAIST: Bracing in Adolescent Idiopathic Scoliosis Trial.

Table 4 Comparative long-term outcomes of adolescent idiopathic scoliosis

Outcome	Untreated AIS	Braced AIS	Surgically treated AIS	Level of evidence
Functional outcomes	Good for curves < 50°; ≥ 50° may develop stiffness and mild limitations	Similar or slightly better than untreated if curve stabilized	Excellent when fusion levels are limited and sagittal balance preserved	II-III
Health-related quality of life	Lower self-image and pain scores in large progressive curves	Comparable to controls when brace successful; prevents decline	High satisfaction; best self-image and satisfaction scores	II
Radiological progression	Curves ≥ 40°-50° progress (0.5°-1°/year)	Bracing halts or slows progression in most moderate curves	Fusion halts curve progression	I (BrAIST) for bracing; II for surgery
Self-image/patient perception	Lower, especially in curves > 60° and with visible deformity	Can be negatively affected during bracing but improves long-term if progression is controlled	Greatest improvement due to correction and cosmetic results	II-III
Pain/back pain	Chronic pain more frequent but usually mild/non-disabling	Similar or slightly less than untreated when bracing is successful	Generally improved pain after correction	II-III
Physical capacity and occupational impact	Most remain active; severe curves (> 60°) may affect physical work	Near-normal function; good occupational outcomes if stabilized	Good occupational outcomes; slight restrictions if fusion extends to lower lumbar	II-III
Surgical avoidance/risks of delayed surgery	High risk of requiring surgery if progression occurs	72% avoid surgery if brace compliance adequate (BrAIST)	Delayed surgery after severe progression linked to higher complications and longer fusions	I for bracing; II for surgery
Overall patient satisfaction	Lower in progressive curves	High if bracing successful	Highest among three groups	II

AIS: Adolescent idiopathic scoliosis; BrAIST: Bracing in Adolescent Idiopathic Scoliosis Trial.