Adult scoliosis and back pain

From available long-term follow-up studies of untreated scoliosis, there seems to be minimal risk of disabling back pain in adult patients who have lumbar curves. A review of all Swedish patients who in 1971 received disability pension because of scoliosis showed very few who had lumbar curves, significantly fewer and with curves of lesser degrees than patients who had thoracolumbar and thoracic curves. Those exhibiting lumbar curves were mostly 60 years of age or older and had curves around 25 degrees only, of the type that can arise as a result of osteoporosis and disc degeneration. Whether severe low-back pain occurs more often in adults who have lumbar curves than in those whose spines are straight is open to question, since calculations presented show approximately the same incidence of surgery performed for back pain in scoliotic patients and in those whose spines are straight. Because scoliosis surgery in the adult carries a high risk and long-term efficacy is unproved, all types of conservative measures must be tried before discussing an operation. Prophylactic surgery to prevent future back pain in young patients who have lumbar curves is not justified.