How do idiopathic scoliosis patients who improve after surgery differ from those who do not exceed a minimum detectable change?

Abstract

Introduction: The minimum detectable change (MDC) of the SRS-22 subtotal score is 6.8 points. With the use of this value, patients who have undergone surgery for idiopathic scoliosis can be dichotomized into two groups: the successful (S) group (those who have reached or exceeded this limit) and the unsuccessful (Un-S) group (those in whom the change was smaller). The aim of this study was to analyze the clinical and radiological differences between these patient groups, as well as those related to the surgical technique.

Material and methods: The study included 91 patients (77 women and 14 men, mean age 18.1 years). All patients completed the SRS-22 questionnaire preoperatively and at follow-up (mean 45.6 months). In addition, radiological and surgical data were collected: levels instrumented, number of fused vertebrae, and use of thoracoplasty.

Results: Based on the MDC of the SRS-22 subtotal score, patients were assigned to the Un-S group (44 cases, 48.4%) or S group (47 cases). Groups were similar in age, sex, number of fused vertebrae, percentage of patients who underwent thoracoplasty, and the upper and lower instrumented levels. The magnitude of the major curve and percentage of correction after surgery were also similar (Un-S group 62.3º, 53.2%; S group 64.3º, 49.9%). As compared to Un-S group, S patients had a poorer preop score in all the SRS-22 domains, and a clinically significant postop improvement in pain, perceived body image, mental health, and subtotal score. In contrast, the Un-S group showed a worsening of pain, function, mental health, and subtotal score, and a clinically nonsignificant improvement in perceived body image on the follow-up questionnaire. There were no significant differences in the satisfaction domain score between groups (4.36 vs. 4.62). On ROC curve analysis, a preop subtotal score of 74 points predicted allocation to the S or Un-S group at follow-up with 79% sensitivity and 76% specificity.

Conclusion: The preop subtotal score of the SRS-22 is a good predictor of the clinical response to surgery.