Health-Related Quality of Life in Patients with Adolescent Idiopathic Scoliosis: A Matched Follow-Up at Least 20 Years After Treatment with Brace or Surgery

Sahlgrenska University Hospital, Göteborg, Sweden

INTRODUCTION: A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age, either with distraction and fusion using Harrington rods (ST, n=156; 145 females and 11 males) or with brace (BT, n=127; 122 females and 5 males) were followed at least twenty years after completion of the treatment.

PURPOSE: To determine the long term outcome in terms of health related quality (HRQL) of life in patients treated for AIS, previously not reported.

METHODS: Ninety-four per cent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnaire, parts of SRS/MODEM'S questionnaire and study-specific questions concerning the treatment, as a part of an unbiased personal follow-up examination, including radiographic examination. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations.

RESULTS: There were no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but significantly reduced physical function using the SF-36 subscales, SF-36/Physical Component Summary (PCS) score as well as the Oswestry Disability Back Pain Questionnaire compared to the controls. Neither the mental subscales and the Mental Component Summary (MCS) score of SF-36 nor the PGWB index showed any significant difference between the groups. Forty-nine per cent of ST, 34% of BT and 15% of controls admitted limitation of social activities due to their back, (p ‹ 0.001 ST vs. controls, p= 0.0010 BT vs. controls and n.s., p=0.024 ST vs. BT), mostly due to difficulties to physically participate in activities or self-consciousness about appearance. Pain was a minor reason for limitation. No correlation could be found between the outcome scores and curve size after treatment, curve type, total treatment time or age at completed treatment.

DISCUSSION AND CONCLUSION: Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population. A minority of the patients (4%) had a severely decreased psychological well-being and a few (1.5%) were physically severely disabled due to the back.