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

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.