Abstract
PurposeTo assess the self-image perception and the Quality-of-Life (QoL) in female adolescents, with Lenke 1C scoliosis curves, treated with selective versus non-selective posterior spinal instrumentation and fusion (PSF).MethodsPatients undergoing PSF for idiopathic adolescent scoliosis (AIS) were recruited and divided into two groups: patients managed with selective thoracic fusion (STF) were included in Group A, whereas patients treated with non-selective fusion (N-STF) in Group B. Each patient completed the Italian version of the Scoliosis Research Society-22R questionnaire (SRS-22R), the Quality-of-Life Profile for Spinal Deformities questionnaire (QLPSD) and the Spinal Appearance Questionnaire (SAQ), before surgery and at 24-month follow-up.ResultsOne hundred and fifty seven female patients (mean age 16.38) were included in this study. 80 patients underwent STF, while 77 patients received N-STF. At 24-month follow-up, patients managed with N-STF showed better SRS-22R self-image mean score (p = .012), SRS-22R satisfaction mean score (p = .033), QLPSD body image mean score (p = .005), but worse SRS-22 function mean score (p = .006) and QLPSD back flexibility mean score (p = .007), compared with patients who underwent STF. In terms of self-image perception, patients undergoing STF showed significantly worse SAQ total mean score (p = .002), SAQ appearance mean score (p = .001) and SAQ expectation (p = .001). We found a significant correlation between SAQ appearance mean score and SRS-22R self-image (R = − 0.721), SRS-22 mental health (R = − 0.8), QLPSD psychosocial functioning (R = 0.7) and QLPSD back flexibility (R = 0.8).ConclusionAlthough the STF of Lenke 1C curves provides better functional outcomes, in the present study, female patients receiving STF revealed a worse perceived body image, compared with patients treated with N-STF, at 24-month follow-up. Particular attention should be addressed to the preoperative patient’s mental health and body image perception, when choosing between STF and N-STF.
Highlights
The surgical treatment of adolescent idiopathic scoliosis (AIS) aims at three-dimensional deformity correction, the achievement of a solid arthrodesis and prevention of the curve progression in future [1]
The Scoliosis Research Society-22R questionnaire (SRS-22R) mental health domain mean score showed a significant improvement in both Groups at 24-month followup, compared with baseline (Group A: p = 0.007; Group B: p = 0.003)
Group B patients showed an improvement of the Quality-of-life profile for spinal deformities (QLPSD) body image domain mean score (p = 0.001) and a concomitant significant impairment of the QLPSD back flexibility domain mean score (p = 0.004), at 24-month follow-up
Summary
The surgical treatment of adolescent idiopathic scoliosis (AIS) aims at three-dimensional deformity correction, the achievement of a solid arthrodesis and prevention of the curve progression in future [1]. All these goals could be achieved with posterior spinal instrumentation and fusion surgery (PSF) with pedicle screws, which currently represents the gold standard for the surgical correction of AIS [2]. The most common scoliosis pattern in AIS is a rightsided major thoracic curve; frequently a concomitant lumbar curve coexists If this lumbar curve is nonstructural, it could be excluded from the fusion area, a selective thoracic fusion (STF) could be performed [4]. The STF success relies on the possibility to obtain a postoperative spontaneous lumbar curve correction, without including it in the fusion area, leading to a well-balanced spine
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