Surgery partially mitigates a 2-decade decline in health-related quality of life for adolescents with idiopathic scoliosis undergoing spinal fusion at 2 years.

Abstract

Purpose: The purpose of this study is to evaluate how 2-year postoperative SRS scores for patients with adolescent idiopathic scoliosis (AIS) who underwent spine fusion have evolved over time.

Methods: Single center, retrospective review of AIS patients who underwent fusion between 2002 and 2020. Patients were included if they completed SRS questionnaires preoperatively and 2-years postoperatively (21-49 months). The SRS has seven scoreable domains: Pain, Appearance, Activity, Mental Health, Subtotal (calculated with the four previous domains), Satisfaction, and Total Score. Domain score range from 1 to 5 (worst-best). Multivariable linear regressions were performed on 2-year SRS domain scores. The primary variable was calendar year of SRS completion, but variables also included: preoperative SRS scores, gender, race, age, and time since surgery (months). Subsequently multivariable linear regressions were performed for the change in SRS scores between preoperative and 2-year.

Results: Seven hundred eighty seven patients (83.7% female, age 14.3 ± 2.0) were included in this study. Of the variables included, preoperative SRS scores, gender, race, and time since surgery contributed significantly to the regression models. More recent calendar years for SRS completion were associated with worse Mental Health and Activity domain scores (coefficient = - 0.010, p = 0.0432; coefficient = - 0.007, p = 0.0340). Each additional year was associated with a ~ 0.01 decline in Mental Health and Activity scores. Regression analysis between preop and 2-year scores found that patients with more recent SRS completion years had greater improvements in Pain and Subtotal scores (coefficient = 0.014, p = 0.013, coefficient = 0.009, p = 0.023).

Conclusion: AIS patients undergoing spinal fusion in more recent years report worse HRQoL in the Activity and Mental Health domains postoperatively. However, Pain and Subtotal scores had greater improvements from preoperative to 2-year, suggesting a mitigating effect of surgery in the setting of declining preoperative scores.