Improvement in quality of life following surgery for adolescent idiopathic scoliosis.
METHODS
We used the Climent Quality of Life for Spinal Deformities Scale prospectively in a nonrandomized prospective comparative cohort of operative versus observational management of adolescent idiopathic scoliosis.


OBJECTIVE
To compare the change in disease-specific quality of life associated with operating on adolescents with idiopathic scoliosis, to the change in disease-specific quality of life among observed scoliosis patients with a similar 2-year follow-up period.


BACKGROUND
The immediate effect of scoliosis surgery on quality of life from a patient perspective has not been properly documented but should play a role in the patient's decision to operate.


METHODS
At a single tertiary referral children's hospital spinal clinic, 119 patients undergoing scoliosis surgery and 42 patients undergoing observation only for scoliosis were enrolled in a prospective study, including preoperative and postoperative spine-specific quality of life. Change in quality of life after 2 years of follow-up among operated versus observed patients (adjusted for baseline quality of life) was used to estimate the short-term benefit of scoliosis surgery.


RESULTS
The operated group experienced an increase in quality of life of 4.3 points (95% confidence interval, 0.69-7.88) on the 115-point Climent scale. Although statistically significant, this increase was lower than the 5.5-point cutoff we had defined a priori as clinically significant.


CONCLUSIONS
Scoliosis surgery results in a small increase in spine-related quality of life at 2 years. This increase is of questionable clinical significance. Decisions to operate on adolescents with scoliosis should acknowledge modest expectations about short-term gains in quality of life.
Howard
Andrew
A
Hospital for Sick Children, Toronto, Ontario, Canada. andrew.howard@sickkids.ca
Donaldson
Sandra
S
Hedden
Douglas
D
Stephens
Derek
D
Alman
Benjamin
B
Wright
James
J
D000293:Adolescent; D001915:Braces; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D012600:Scoliosis / Q000523:psychology* / Q000601:surgery* / Q000628:therapy; D013123:Spinal Fusion / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards; D016896:Treatment Outcome