Improvement in quality of life following surgery for adolescent idiopathic scoliosis

Study Design. 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. Summary of Background Data. 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. Conclusion. 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.