Prospectively Collected Comparison of Outcomes Between Surgically and Conservatively Treated Patients with Adolescent Idiopathic Scoliosis

Colin M Whitaker; Firoz Miyanji; Amer F Samdani; Joshua M Pahys; Paul D Sponseller; Tracey P Bastrom; Peter O Newton; Steven W Hwang; Harms Study Group

doi:10.1097/BRS.0000000000004948

Prospectively Collected Comparison of Outcomes Between Surgically and Conservatively Treated Patients with Adolescent Idiopathic Scoliosis

Spine (Phila Pa 1976). 2024 Feb 2. doi: 10.1097/BRS.0000000000004948. Online ahead of print.

Authors

Colin M Whitaker¹, Firoz Miyanji², Amer F Samdani³, Joshua M Pahys⁴, Paul D Sponseller⁵, Tracey P Bastrom⁶, Peter O Newton⁷, Steven W Hwang⁴; Harms Study Group

Affiliations

¹ St. Luke's University Hospital, Bethlehem, PA 18015.
² BC Children's Hospital, Vancouver, BC, Canada.
³ Shriners Children's - Philadelphia, Philadelphia, PA 19140 USA.
⁴ Shriners Children's - Philadelphia, Philadelphia, PA, 19140 USA.
⁵ The Johns Hopkins University, Baltimore, MD, 21287 USA.
⁶ Rady Children's Hospital, San Diego, CA 92123, USA.
⁷ Rady Children's Hospital, San Diego, CA, 92123 USA.

PMID: 38305301
DOI: 10.1097/BRS.0000000000004948

Abstract

Study design: Retrospective review of a prospectively collected multicenter registry.

Objective: To evaluate health-related quality of life (HRQOL) measures in an operative cohort of patients (OP) and compare them with a matched nonoperative cohort (NON).

Summary of background data: Historically, the surgical outcomes of adolescent idiopathic scoliosis (AIS) have been radiographically evaluated. However, the importance of HRQOL measures and their impact on surgical outcomes are increasingly being understood.

Methods: We identified 90 NON patients with curves in the operative range who were observed for at least 2 years. These patients were matched with an OP cohort of 689 patients. All patients completed the Scoliosis Research Society-22 (SRS-22) questionnaire at the initial evaluation and at a minimum of 2-year follow-up. Subgroup comparisons were based on curve type: primary thoracic (Th), primary thoracolumbar/lumbar (TL/L), and double major (DM) curves.

Results: The preoperative major curves in the Th, TL/L, and DM OP subgroups averaged 50.4°, 45.4°, and 51.5°, respectively, and 49.4°, 43.7°, and 48.9° in the NON cohort (P > 0.05). At 2 years postoperatively, the major curve in the Th, TL/L, and DM OP subgroups improved to 19.0°, 19.2°, and 19.3°, respectively, compared to the progression to 51.3°, 44.5°, and 49.7° in the NON group at 2-year follow-up (P < 0.05). The SRS-22 self-image, mental health, satisfaction, and total scores at the 2-year follow-up were significantly better in all OP subgroups (P < 0.001) but remained largely unchanged in the NON group. A significant percentage of patients (P < 0.001) in the OP cohort reported better SRS-22 scores at the 2-year follow-up in the self-image, mental health, and satisfaction domains than the NON group at 2 years.

Conclusions: Surgically treated patients with AIS have improved HRQOL outcomes in several domains compared to age- and curve magnitude-matched nonoperatively treated patients at 2-year follow-up.