The Canadian Scoliosis Screening Coalition

www.ScoliosisCanada.ca            contact us by email: CSSC@scoliosiscanada.ca

Links to Publications on the Long-term Impact of Adolescent Idiopathic Scoliosis (AIS) into Adulthood:

Added May 5, 2025. Revised Dec 22, 2025

The following is a curated list of links. Adolescent Idiopathic Scoliosis is also referred to as Idiopathic Scoliosis.

1. Gurjovan Sahi, Jin Tong Du,Aazad Abbas, Sager Hanna, Neil Berrington, Alysa Almojuela, Michael Johnson, Stephen Lewis, Michael Goytan, Jay Toor The Spinal Invasiveness Score can better quantify surgical wait-lists across Canada. Canadian Journal of Surgery Vol. 68 (6 Suppl 3) December 12, 2025 (page 68) DOI: 10.1503/cjs.020125 Abstract ID 149 Program Code P169, The University of Toronto, Toronto, Ont.; University of Manitoba, Winnipeg, Man., "Background: Canadian spine care delivery is in crisis owing to inordinate patient wait times. Relying on the current method of a simple count of patients awaiting surgery leads to disproportionate wait time estimations depending on pathology; for example, patients with scoliosis wait longer than those needing simple discectomies. Using the Spinal Invasiveness Score (SIS) to categorize surgeries is a comprehensive solution; it is a validated scoring system that assigns points based on surgical invasiveness across 6 parameters. Wait-lists can then be calculated based on SIS score, with additional benefits such as subcategorization of wait times and initiatives to target specific subcategories of procedures. This study aims to evaluate spine surgeons’ and hospital administrators’ perceptions of adopting the SIS model for spine surgery wait-list management. Methods: A qualitative descriptive study was conducted surveying spine surgeons and hospital administrators across Canada. Participants reviewed a case study comparing the current waitlist model with the SIS-based approach and were surveyed on their...Results: Of the 21 respondents, 17 (81%) preferred the SIS approach over the existing system, including 9 of 11 surgeons and 8 of 10 administrators... Conclusion: The SIS method was overwhelmingly well received, with numerous benefits identified as well as potential barriers and room for improvement. The SIS score has shown early success in advocating for more tailored operating room (OR) scheduling, such as longer OR days to accommodate complex surgeries. With careful implementation and adaptation, SIS could become a key part of nationwide wait-list management strategies." (note: Unacceptable long-wait times for complex spine surgery (more then 2 levels of vertebrae, which invariably represents patients with Scoliosis) has been a healthcare crisis reported by the main-stream media for more then several years now. )
2. Daisy A. Lu, Zhi Wang, M. Fidaa Al-Shakfa, Jesse Shen. Transitioning from pediatric to adult scoliosis care: defining the perspectives of these patients during this critical period.Canadian Journal of Surgery Vol. 68 (6 Suppl 3) (page 72) December 12, 2025 DOI: 10.1503/cjs.020125, Abstract ID 57, Program Code P177, From the Université de Montréal, Montréal,Que.; Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Que., "Background: This prospective study seeks to define parents’ and patients’ expectations, needs, and experience with pediatric spinal deformity upon “graduation” from their pediatric centre. As a subaim, administrative and health care workers (nurses, physicians, schedulers, secretaries who are in contact with patients) will also be interviewed to obtain their experience and perspective on connecting patients between pediatric and adult hospital centres. Methods: Patients between the ages of 18 and 35 years who have had a diagnosis of scoliosis and have been previously treated at a pediatric hospital, parents of such patients, and current members of either pediatric or adult spine care teams managing such patients were included in our study... Results: Preliminary results suggest the need for an integrative standardized transition protocol with increased communication and information sharing among all parties involved. Conclusion: Transitioning from pediatric to adult care presents distinct challenges for patients with scoliosis, often resulting in fragmented care and diminished health outcomes. Effective transition models that integrate patient education, coordinated provider communication, and individualized accompaniment plans may enhance patient engagement and continuity of care. There is a need for further refining and standardizing transition plans to better support young adults in managing chronic spine conditions as they enter adult care settings."
3. Ansari K, Singh M, McDermott JR, Gregorczyk JA, Balmaceno-Criss M, Daher M, McDonald CL, Diebo BG, Daniels AH. Adolescent idiopathic scoliosis in adulthood. EFORT Open Rev. 2024 Jul 1;9(7):676-684. doi: 10.1530/EOR-23-0162. PMID: 38949156; PMCID: PMC11297403. ”...As adolescents with AIS enter adulthood, condition outcomes vary with some experiencing curve stabilization and others noting further curve progression, chronic pain, osteoporosis/fractures, declines in pulmonary and functional capacity, among others. Regular monitoring and individualized management by healthcare professionals are crucial to address the diverse challenges and provide appropriate support for a fulfilling adult life with AIS....”
4. Yetiş M, Yildiz NT, Canli M, Kocaman H, Yildirim H, Alkan H, Valamur İ. Determination of predictors associated with pain in non‑surgically treated adults with idiopathic scoliosis. J Orthop Surg Res. 2024 Jul 16;19(1):406. doi: 10.1186/s13018-024-04912-8. PMID: 39014368; PMCID: PMC11253333."It is recognized that pain related to adult individuals with idiopathic scoliosis (IS) substantially impacts individuals’ daily activities and quality of life... Strong associations were found between pain severity with curvature severity, spinal mobility, trunk rotation angle, perception of cosmetic deformity, disability, and quality of life..."
5. Alcala C, Mehbod AA, Ramos O, Dawson JM, Denis F, Garvey TA, Perra JH, Beauchamp E, Transfeldt EE. Moderate scoliosis continues to progress at 30 year follow-up: a call for concern? Spine Deform. 2024 Jan;12(1):89-98. doi: 10.1007/s43390-023 00765-z. Epub 2023 Sep 27. PMID: 37755682. “Conclusion: All AIS curves between 30° and 50° at skeletal maturity tend to progress....”
6. ... Progression factors of curves >30% at skeletal maturity, Back Pain ), from the Scoliosis Research Society Education Resource Center. See table 1. "...Studies have consistently shown the more skeletally immature a patient is, the greater the chance of progression. It also shown the larger the curve at presentation, the higher the probability of progression of the deformity. There is also a greater risk of progression before the onset of menarche in females..."
7. Quintero Santofimio V, Clement A, O'Regan DP, Ware JS, McGurk KA. Identification of an increased lifetime risk of major adverse cardiovascular events in UK Biobank participants with scoliosis. Open Heart. 2023 May;10(1):e002224. doi: 10.1136/openhrt-2022-002224. PMID: 37137668; PMCID: PMC10163590.
8. Ragborg LC, Dragsted C, Ohrt-Nissen S, Andersen T, Gehrchen M, Dahl B. Health-related quality of life in patients 40 years after diagnosis of an idiopathic scoliosis. Bone Joint J. 2023 Feb;105-B(2):166-171. doi: 10.1302/0301-620X.105B2.BJJ 2022-0897.R1. PMID: 36722050. “...we found a significantly decreased HRQoL (Health related quality of life) and capacity to work in patients with an idiopathic scoliosis 40 years after diagnosis”
9. Akazawa T, Kotani T, Sakuma T, Iijima Y, Torii Y, Ueno J, Yoshida A, Eguchi Y, Inage K, Matsuura Y, Suzuki T, Niki H, Ohtori S, Minami S. Long-term changes in bone mineral density following adolescent idiopathic scoliosis surgery: a minimum 34-year follow-up. Eur J Orthop Surg Traumatol. 2024 Jan;34(1):425-431. doi: 10.1007/s00590-023-03678-9. Epub 2023 Aug 11. PMID: 37566138. "Conclusion: Significant reductions in BMD (Bone Mineral Density) and an increased prevalence of osteopenia and osteoporosis were observed in middle-aged female AIS patients who had undergone spinal fusion. The decline in Z-scores in patients with AIS suggested that there was an accelerated loss of BMD compared with the general population. Larger residual curves could pose an added osteoporosis risk. Further research is needed to understand if the onset of osteoporosis in AIS patients is attributable to the condition itself or the surgical intervention.(note: this is likely true of all patients with AIS, fused or not, according to other published studies)
10. Erwin J, Carlson BB, Bunch J, Jackson RS, Burton D. Impact of unoperated adolescent idiopathic scoliosis in adulthood: a 10-year analysis. Spine Deform. 2020 Oct;8(5):1009-1016. doi: 10.1007/s43390-020-00142-0. Epub 2020 May 28. PMID: 32468383.”Conclusions: Patients with AIS have SRS-22r scores that are lower than age-gender matched controls in most domains. ODI had a positive linear correlation with age, body mass index, and curve size. Only 10% of adults with surgical-size curves evaluated for scoliosis elected to undergo surgery. Patients treated surgically reported worse preoperative quality-of-life scores than their non surgical counterparts. These results can help healthcare providers when counseling patients and families concerning management options.”
11. Ohashi M, Watanabe K, Hirano T, Hasegawa K, Katsumi K, Shoji H, Mizouchi T, Endo N. Predicting Factors at Skeletal Maturity for Curve Progression and Low Back Pain in Adult Patients Treated Nonoperatively for Adolescent Idiopathic Scoliosis With Thoracolumbar/Lumbar Curves: A Mean 25-year Follow-up. Spine (Phila Pa 1976). 2018 Dec 1;43(23):E1403-E1411. doi: 10.1097/BRS.0000000000002716. PMID: 30422957. “...We aimed to clarify the predicting factors at skeletal maturity for future curve progression and low back pain (LBP) in adolescent idiopathic scoliosis (AIS) with thoracolumbar/lumbar (TL/L) curve. .. Summary of background data: TL/L curves are likely to progress after skeletal maturity and cause LBP....Great L3 and L4 tilt at skeletal maturity, especially those >16°, are predictors of future curve progression and LBP in adulthood, respectively. For adolescent patients with these risk factors, periodic follow-ups into adulthood should be considered.”
12. Pellisé F, Vila-Casademunt A, Ferrer M, Domingo-Sàbat M, Bagó J, Pérez-Grueso FJ, Alanay A, Mannion AF, Acaroglu E; European Spine Study Group, ESSG. Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J. 2015 Jan;24(1):3-11. doi: 10.1007/s00586-014-3542-1. Epub 2014 Sep 14. PMID: 25218732."...Comparable scores for patients with ASD ranged from -10.9 to -45.0. Physical function, role physical and pain domains showed the worst scores. Surgical candidates with ASD displayed the worst HRQL scores (-17.4 to -45.0) and patients previously operated the best (-10.9 to -33.3); however, even the latter remained worse than any scores for the other self-reported chronic conditions. Conclusions: The global burden of ASD was huge compared with other self-reported chronic conditions in the general population of eight industrialized countries. The impact of ASD on HRQL warrants the same research and health policy attention as other important chronic diseases.
13. Freidel K, Reichel D, Steiner A, Warschburger P, Petermann F, Weiss HR. Idiopathic scoliosis and quality of life. Stud Health Technol Inform. 2002;88:24-9. PMID: 15456000. “The results indicate that idiopathic scoliosis in children, adolescents and adults can be regarded as a risk factor for the impairment of health related quality of life and thus stress the importance of psychosocial offers...”
14. Freidel K, Petermann F, Reichel D, Steiner A, Warschburger P, Weiss HR. Quality of life in women with idiopathic scoliosis. Spine (Phila Pa 1976). 2002 Feb 15;27(4):E87-91. doi: 10.1097/00007632-200202150-00013. PMID: 11840115. “...juvenile patients with idiopathic scoliosis were unhappier with their lives (P = 0.001). They reported more physical complaints (P < 0.001) and had lower self-esteem (P = 0.01) and higher depression scores (P = 0.021). Adult patients reported more psychologic (P < 0.001) and physical impairment than in the population norm (P < 0.001)”
15. Cordover AM, Betz RR, Clements DH, Bosacco SJ. Natural history of adolescent thoracolumbar and lumbar idiopathic scoliosis into adulthood. J Spinal Disord. 1997 Jun;10(3):193-6. PMID: 9213273. https://pubmed.ncbi.nlm.nih.gov/1411763/ Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine (Phila Pa 1976). 1992 Sep;17(9):1091-6. doi: 10.1097/00007632-199209000-00014. PMID: 1411763.
16. Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M. Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine (Phila Pa 1976). 1986 Oct;11(8):784-9. doi: 10.1097/00007632-198610000-00007. PMID: 3810293. “A total of 187 random cases of untreated idiopathic scoliosis, seen from a minimum of 15 to a maximum of 47 years after the end of growth, were reviewed. All curves increased after skeletal maturity (average progression: 0.4 degrees per year). Thoracic curves tend to progress more than lumbar, lumbar more than thoracolumbar, and thoracolumbar more than double major curves. Pain was present in 114 cases (61%) and appeared more frequently in women, after pregnancies, and with fatigue. Cardiopulmonary symptoms were present in 42 patients (22%), especially those with thoracic and thoracolumbar curves greater than 40 degrees. Psychologic disturbances were found in 35 cases (19%), mostly female patients with thoracic curves greater than 40 degrees...In an unselected group of patients with severe curves a mortality rate of 17% was found, twice as much as in the Italian general population.”
17. Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg Am. 1981 Jun;63(5):702-12. PMID: 6453874.

Pregnancy and AIS

1. Serhan, Karolina A. MD1; Abraham, Vivek M. MD1; Shirley, Eric D. MD1,a. The Impact of Adolescent Idiopathic Scoliosis on Pregnancy. The Journal of Bone and Joint Surgery 107(7):p 771-777, April 2, 2025. | DOI: 10.2106/JBJS.24.00850

   "Abstract: ➢ Physiologic changes during pregnancy alter the biomechanics of the spine, including increased ligamentous laxity, lumbar lordosis, and pelvic tilt. ➢ Patients with adolescent idiopathic scoliosis treated with a fusion construct with the lowest instrumented vertebra of L3 and below have an increased risk of developing low back pain during pregnancy. ➢ There is a low risk of curve progression during pregnancy for patients with adolescent idiopathic scoliosis treated with spinal fusion. ➢ Although neuraxial anesthesia is possible in patients who had previously undergone spinal fusion for adolescent idiopathic scoliosis, successful placement may require a more experienced provider and more attempts to place the epidural."

2. Grabala P, Kowalski P, Grabala M. From Rib Hump to Baby Hump-Common Questions of Patients Suffering from and Undergoing Treatment for Scoliosis-A Comprehensive Literature Review. J Clin Med. 2024 Jun 28;13(13):3814. doi: 10.3390/jcm13133814. PMID: 38999380; PMCID: PMC11242321. “...Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra....The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation....”
3. Nandoliya KR, Sadagopan NS, Alwakeal A, Kemeny H, Cloney M, Dahdaleh NS, Koski T, El Tecle N. Adolescent Idiopathic Scoliosis and Pregnancy. Cureus. 2023 Oct 10;15(10):e46782. doi: 10.7759/cureus.46782. PMID: 37954752; PMCID: PMC10633849. “...Conclusions Patients with AIS had comparable rates of c-section to the general population, and even among patients with AIS, a history of spinal fusion was not associated with an increased incidence of c-section. Adolescent idiopathic scoliosis may be associated with difficulty administering anesthesia in a minority of patients, which can lead to a lower rate of combined spinal and epidural anesthesia usage. Furthermore, most patients with AIS will experience increased back pain during and after pregnancy. Changes in Cobb angle are seen in many patients, but the clinical significance of these changes remains unknown....”
4. Theroux J, Brown BT, Marchese R, Selby M, Cope V, McAviney J, Beynon A . The impact of pregnancy on women with adolescent idiopathic scoliosis: a scoping review. Eur J Phys Rehabil Med. 2023 Aug;59(4):505-521. doi: 10.23736/S1973-9087.23.08086-3. PMID: 37746783; PMCID: PMC10548399. “...there remains a paucity of information on the effect of pregnancy on scoliosis. More robust longitudinal studies are needed to enhance our understanding and to inform health professionals who manage AIS patients. Our scoping review results may provide important information in counselling female patients with scoliosis who are contemplating pregnancy.”.(Canada)
5. Cao Y, Shu S, Jing W, Zhu Z, Qiu Y, Bao H Quality of Life During Pregnancy, Caesarean Section Rate, and Anesthesia in Women with a History of Anterior Correction Surgery for Lumbar Scoliosis: A Case-Control Study. Med Sci Monit. 2020 Oct 17;26:e926960. doi: 10.12659/MSM.926960. PMID: 33067410; PMCID: PMC7577072.