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

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. Materials and Methods. We identified 90 NON patients with curves in the operative range who were observed for at least two 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 two-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 two 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 with the progression to 51.3°, 44.5°, and 49.7° in the NON group at two-year follow-up (P<0.05). The SRS-22 self-image, mental health, satisfaction, and total scores at the two-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 two-year follow-up in the self-image, mental health, and satisfaction domains than the NON group at two years. Conclusions. Surgically treated patients with AIS have improved HRQOL outcomes in several domains compared with age-matched and curve magnitude-matched nonoperatively treated patients at two-year follow-up.