Impact of Surgery on the Quality of Life of Adolescent Idiopathic Scoliosis.

Background: The impact of surgery on the quality of life of adolescents with idiopathic scoliosis (AIS) remains to be clarified as most of the studies are retrospective and few include quality of life questionnaires completed in the pre- and postoperative periods.

Methods: Operated patients with AIS who completed preoperative and postoperative SRS-22 questionnaires were selected for evaluation. The demographic data were collected and quality of life improvement was assessed by comparing deviation to the means with standard deviation at both moments. Using the Minimal Important Clinical Difference (MICD) concept, individual improvement was also assessed.

Results: 28 patients (27 females) with an average age of 14.4 years (min: 12 - max: 18) and an average Cobb angle of 61.46º (min: 35º- max: 98º) were retrospectively reviewed. The correction rate was 68% with a final Cobb angle of 18.97º (min: 7.37º - max: 37.6º). The Global SRS22 score and all sub domains showed a significant variation (p<0,01). Self-image, followed by mental health, were the subdomains where the mean differences was more relevant, with the highest effect dimension given by d-Cohen analyses (Self-image d-Cohen 2.51; Mental health -d-Cohen 0.86). Both mean score differences as well as global SRS22 score reached the MICD but, while 96.4% of the patients did so for self-image ,the same only happened in 50% of the patients in Mental health and global score. No clinical relevant change occurred in pain or activity domains.

Conclusion: Taking into consideration the AIS natural history and the fact that the most relevant change after surgery occurs in patients' self-esteem, the advantages of a surgical treatment should be thoroughly evaluated not only based on curve severity but also by looking at which quality of life subdomains are mostly affected and which are expected to improve in order to meet proper patient expectations..