Parents' and patients' perceptions of postoperative appearance in adolescent idiopathic scoliosis

Study Design. A cross-sectional evaluation of patients after surgery for adolescent idiopathic scoliosis (AIS). Objectives. To determine the agreement between patients' and parents' perceptions of the patient's postoperative appearance and to compare those perceptions with physical and radiographic measures of deformity. Summary of Background Data. Improving cosmesis is an important aim of surgery. Patients' appearances may influence their evaluation of its outcome. Methods. Physical and radiographic data were collected 2 years after surgery for 128 patients with AIS. Patients and parents independently rated shoulder blades, shoulders, waist, and overall appearance. Additionally, patients completed the Quality of Life Profile for Spinal Disorders (QLPSD). Agreement was evaluated with the weighted kappa statistic ranging between 0 and 1 where higher values indicate better agreement. Results. Fair to moderate agreement was found between patient and parent ratings of the patient's shoulder blades (kappa = 0.39; 95% confidence interval [CI], 0.29 0.48), shoulders (kappa = 0.38; 95% CI, 0.26-0.50), waist (kappa = 0.45; 95% CI, 0.25-0.55), and overall appearance (kappa = 0.22; 95% CI, 0.04-0.40). Patients rated the appearance of their waist (P = 0.013) and overall appearance (P = 0.039) significantly worse than their parents. Patients' perceptions of their overall appearance had higher correlations with the body image subscale score (r = 0.45, P = 0.000) and the total quality of life score on the QLPSD (r = 0.37, P = 0.000) than did parents' perceptions of those same measures (r = 0.21, P = 0.025; and r = 0.08, P = 0.369, respectively). Conclusions. Radiographic and physical measures of deformity do not correlate well with patients' and parents' perceptions of appearance. Patients and parents do not strongly agree on the cosmetic outcome of AIS surgery. Therefore, given that the adolescents themselves undergo the surgery, patients' assessments of their deformity, rather that radiographic measures or parents' assessments, play a major role in the evaluation of surgical success.