Thirty years later: the lingering effects of adolescent idiopathic scoliosis surgery with third-generation implants on quality of life.

Purpose: To determine patient-reported clinical status in a cohort of patients operated on during adolescence for adolescent idiopathic scoliosis (AIS) using Cotrel-Dubousset instrumentation after a minimum follow-up (FU) of 25 years.

Methods: Multicentric cross-sectional observational study. We assessed the clinical status of patients using the lumbar-pain numeric rating scale (NRS), ODI, SRS-22r, SF-36, and EQ-5D-5L. For NRS and SRS-22r, the reported "Patient Acceptable Symptom State" (PASS +) was used as a reference for normality. Further, normative data were used for SF-36 and EQ-5D-5L.

Results: Out of 226 eligible patients, 152 (67% of the total; 87% female) were included (mean FU = 29.6 years). The mean age at FU was 45.1 years (SD3.4; range 36-55). The PASS + status was achieved by 56.7% of patients on the SRS-22 subtotal score, 56% of patients in the NRS and 56.8% in the ODI questionnaire achieving PASS + state. Significant differences were found between the normative values for the SF-36 and EQ-5D-5L scores, but the magnitude of the differences was not clinically relevant. Clinically significant differences were found for SF-36 bodily pain (43.0 vs. 50.0; p < 0.001), SF-36 PCS (42.8 vs. 50.0; p = 0.0001) and EQ-5D-5L pain score, with the scoliotic population having 4.1 times more risk of severe/extreme pain than their peers.

Conclusions: Thirty years after surgery, AIS patients have more pain and worse physical functioning than their peers. However, the differences are not clinically relevant except for pain and physical activity. Further, on average, the former are in good clinical condition, although surgery has not normalized their lives.