Quality of Life Improvement Following Surgery in Adolescent Spinal Deformity Patients: A Comparison Between Scheuermann Kyphosis and Adolescent Idiopathic Scoliosis

Abstract

Study design: Preoperative and two-year follow-up health-related quality of life (HRQOL) data were prospectively collected in 82 Scheuermann kyphosis (SK) and 995 adolescent idiopathic scoliosis (AIS) patients using the Scoliosis Research Society-22 patient questionnaire (SRS-22) outcomes instrument in a multicenter study. Visual analog scale (VAS) scores were also collected for the SK population.

Objectives: This study assessed changes in HRQOL prospectively and compared them to those occurring in AIS.

Summary of background data: There has been limited evaluation of patient-reported HRQOL changes with operative management of SK.

Methods: Median SRS values for the SK and AIS cohorts were compared using a repeated measure of analysis of variance with age as a covariate and using a Mann-Whitney U nonparametric comparison.

Results: Kyphosis was corrected from 73.9° to 45.8° (p < .001); the major curve in AIS was corrected from 55.5 to 20.2 (p < .001). Preoperative and magnitude of radiographic correction, kyphosis apex and body mass index in SK were not correlated with baseline or change in HRQOL. SK SRS scores improved after surgery in all domains with the greatest change (2.8-4.4) in self-image (p < .001). Changes in SRS Pain, Activity, and Self-Image domains met the minimal clinically important difference. Baseline SK and AIS scores differed significantly in the Self-Image, Mental Health and Total Score domains, with SK having worse scores (p < .001). At two years postoperatively, the greatest improvements were made in Self-Image, along with Mental Health and Total Score, and the SK group achieved greater gains (p < .001). At two years postoperatively, the SK scores improved to reach equivalent values to the AIS scores. VAS scores improved from 3.69 to 1.51, and these changes were correlated with change in the Pain, Mental Health, and Total Score SRS domains (p < .001).

Conclusions: Surgery for SK in the adolescent population results in significant improvements in HRQOL, which outpace those of the AIS population.

Level of evidence: Level II.

Keywords: Adolescent idipathic scoliosis; Health-related quality of life; Pain; Scheuermann's kyphosis; Scoliosis Research Society Questionnaire; Self-Image.