Patients' perceptions of overall function, pain, and appearance after primary posterior instrumentation and fusion for idiopathic scoliosis

Study Design. This outcome study used patients' responses to the Scoliosis Research Society Outcomes Instrument to discriminate among patients who had undergone surgery for correction of juvenile or adolescent idiopathic scoliosis. Objectives. To evaluate a surgically treated population by using the SRS Outcomes Instrument. Summary of Background Data. The Scoliosis Research Society outcomes instrument was developed to help evaluate patient-perceived outcomes after treatment for idiopathic scoliosis. It includes 24 questions designed to investigate seven domains. Methods. Eligible patients underwent posterior surgery for the first time before their 21st birthdays. One surgeon performed the surgery at one medical center. Of 168 eligible patients, 121 (72%) completed the Scoliosis Research Society outcomes questionnaire. Results. Females reported better outcomes in the function after surgery (P = 0.005) and self-image after surgery (P = 0.01) domains. Preoperative curve pattern comparison demonstrated a significant difference in self-image after surgery among four groups classified according to curve pattern. The thoracolumbar and lumbar group recorded image scores of 5, the highest possible score, 85% of the time. The King-Moe (KM) V group scored 5, 75% of the time; the KM I and II group 48%; and the KM III and IV group 46% (P = 0.0015). After eliminating confounding variables, it was found that white patients reported experiencing less pain in follow-up than did black patients (P = 0.0098). Results were also suggestive that less pain was associated with increased number of fused vertebrae (P = 0.027). Conclusions. The strongest predictors of self-perceived favorable outcome among patients were female sex and white race. It is also suggested that longer fusions to L1 through L3 lead to less perceived pain than with shorter fusions.