Scoliosis Research Society-22 Patient Questionnaire Research Articles

Surgical Treatment Strategies for Ankylosing Spondylitis with “Folded Man” Deformity: A Single-Center Retrospective Case Series Study

Ankylosing spondylitis (AS) combined with severe kyphotic deformity can cause the trunk to collapse, pressing tightly against the front of the thighs and forming a "folded man" deformity. The purpose of this article is to evaluate the effectiveness and safety of a treatment strategy for correcting the "folded man" deformity. A retrospective study was conducted to analyze 12 AS patients with "folded man" deformity treated at our hospital with staged kyphosis correction in the lateral position, followed by total hip arthroplasty, from May 2018 to July 2021. Global kyphosis (GK), thoracic kyphosis, lumbar lordosis, sagittal vertical axis, chin-brow vertical angle, and Scoliosis Research Society-22 Patient Questionnaire scores were compared preoperation and postoperation. Surgical duration, positioning time, blood loss, and complications were also recorded and analyzed. All patients demonstrated a correction of the "folded man" deformity, achieving sagittal balance and horizontal gaze with mild complications. Postoperatively, there were significant improvements in spinal sagittal parameters (GK, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis) and chin-brow vertical angle compared to preoperative values (P < 0.05). The preoperative GK of 139.6 ± 9.1° was corrected to 55.3 ± 5.7° postoperatively, with a mean correction of 84.3°. The standardized treatment strategy involving staged correction of spinal kyphosis in a lateral position, followed by subsequent total hip arthroplasty, offers a safe and effective solution for managing AS with "folded man" deformity.

Gender-Related Factors Influence the Subjective Perception of Deformity in Patients Undergoing Surgery for Idiopathic Scoliosis.

The present study aims to depict the importance of gender-related factors in the subjective perception of spine deformity in adolescents undergoing posterior instrumented fusion for scoliosis. Patients undergoing posterior spinal instrumentation and fusion (PSF) for idiopathic adolescent scoliosis (AIS) were recruited. The following data were recorded: gender, age, parents' civil status, Tegner Activity Scale (TAS), body mass index (BMI), concomitant diseases, and history of neuropsychological disorders. Each patient underwent clinical and radiological evaluations according to the protocol used at our institution. All the patients were assessed before surgery using the following Patient-Reported Outcome Measures (PROMs): the Italian version of the revised Scoliosis Research Society-22 patient questionnaire (SRS-22R), the Quality-of-Life Profile for Spinal Deformities (QLPSDs) questionnaire, and the Spinal Appearance Questionnaire (SAQ). The present study recruited 80 patients (male: 19, female: 61). A significant correlation was observed between BMI, TAS, and subjective perception scores. A worse deformity perception was observed in female patients and patients with divorced parents. Gender-related factors impact the subjective perception of spine deformity in patients undergoing PSF for AIS. Specific assessment and correction are needed to improve postoperative outcomes in these patients.

The Correlation of Global Spinal Realignment With the Quality of Life After Corrective Surgery for Delayed Thoracolumbar Osteoporotic Fracture-Related Kyphosis.

Few studies have been conducted to evaluate the precise impact of corrective surgery on sagittal spinal realignment and clinical outcomes in cases of delayed thoracolumbar osteoporotic fracture-related kyphosis. To assess the efficacy of corrective surgery on sagittal spinal alignment and investigate the relationship between spinal alignment and health-related quality of life (HRQoL) in patients with delayed thoracolumbar osteoporotic fracture-related kyphosis. A total of 78 patients were enrolled. The characteristics and surgical variables were meticulously documented. The sagittal spinal parameters were measured, and the HRQoL was evaluated using Oswestry Disability Index (ODI), SF-12 Physical Component Score (SF-12 PCS), and Scoliosis Research Society-22 Patient Questionnaire (SRS-22) before and after surgery. The changes in spinal parameters and HRQoL were analyzed through the paired t -test. The Pearson correlation analysis was performed to analyze the correlation of parameters with HRQoL. Then, a multiple stepwise regression analysis was performed with HRQoL scores as the dependent variable and spinal parameters as the independent variable. The operative time was 185.9 ± 33.2 min, and the estimated blood loss was 782.8 ± 145.2 mL. The results of the paired t -test revealed a significant difference preoperatively and at the final follow-up in the thoracic kyphosis, thoracolumbar kyphosis (TLK), lumbar lordosis, T9 tilt, pelvic tilt, sacral slope, sagittal vertical axis, and spinosacral angle as well as the ODI, SF-12 PCS, and SRS-22 ( P < .05). Multiple stepwise regression analysis revealed that TLK and pelvic tilt, TLK and sagittal vertical axis, and TLK were the primary parameters affecting the ODI, SF-12 PCS, and SRS-22, respectively. Corrective surgery can effectively realign the global spine and improve HRQoL in patients with delayed thoracolumbar osteoporotic fracture-related kyphosis. The change of TLK is a driving factor to realign the global spine.

Staged osteotomy in lateral position for the treatment of severe kyphotic deformity secondary to ankylosing spondylitis: a retrospective study

BackgroundPatients with severe kyphotic deformity (Cobb > 100°) secondary to ankylosing spondylitis (AS) occasionally cannot undergo corrective surgery in the prone position. Osteotomy in the lateral position might provide a possible solution. In this study, we aim to evaluate the clinical efficacy and safety of staged osteotomy in the lateral position for the treatment of AS-related severe kyphosis with a minimum of 2-year follow-up.MethodsIn total, 23 patients who underwent staged osteotomy in the lateral position from October 2015 to June 2017 were analyzed. In the first stage of surgery, all but one patient underwent a single-level Ponte osteotomy, which was followed by a pedicle subtraction osteotomy in the second stage. Mean follow-up was 30.8 ± 4.6 months. Global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), osteotomized vertebra intervertebral angle (OVI), chin-brow vertical angle (CBVA), Oswestry Disability Index (ODI) score and Scoliosis Research Society-22 Patient Questionnaire (SRS-22) were all compared pre- and postoperation.ResultsAll kyphosis parameters were significantly improved (all P < 0.05). GK was corrected from 115.0 ± 13.4° to 46.5 ± 9.0° postoperatively, with a mean correction of 68.5°. SVA was improved from 21.2 ± 5.1 cm to 5.1 ± 1.8 cm postoperatively. After surgery, CBVA was adjusted from 64.1 ± 23.2° to 5.7 ± 10.6° and OVI was changed from 9.0 ± 2.7° to − 20.1 ± 5.6°. Both the ODI and SRS-22 showed substantial improvements (all P < 0.05). Four patients with mild complications were observed perioperatively.ConclusionIn AS patients with severe kyphosis, satisfactory correction can be safely achieved with staged osteotomy in the lateral position, which can not only correct the sagittal imbalance of the spine with acceptable complications but also facilitate the placement of the intraoperative position.

Decreased rehabilitation adherence, physical activity, and quality of life in individuals with idiopathic scoliosis in the COVID-19 Pandemic

Purpose: This study compares the rehabilitation adherence, physical activity (PA) levels, and quality of life (QoL) of individuals with idiopathic scoliosis (IS) during and before the COVID-19 Pandemic. Methods: This study included 74 individuals with IS between the ages of 9 and 18 years. The Exercise Adherence Rating Scale (EARS) was used to assess adherence to exercise therapy protocols, the International Physical Activity Questionnaire Short Form (IPAQ) was used to evaluate PA levels, and the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) was used to measure QoL. Results: Section B score of the EARS decreased (p=0.041), while Section C (p=0.636) and summed scores (p=0.54) did not change during the pandemic. The PA of the participants decreased (p=0.001), hours of sitting increased (p&amp;lt;0.001). While the body image, pain, and treatment satisfaction scores did not change; the function, mental health, subtotal, and total scores of the participants (respectively p=0.876, p=0.092, p=0.224, p=0.008, p&amp;lt;0.001, p&amp;lt;0.001, p&amp;lt;0.001) decreased. Conclusion: The rehabilitation adherence in individuals with IS was affected negatively, PA levels decreased, sedentary behaviors increased, and QoL of participants decreased during the pandemic. In addition to other factors, the decreased PA levels in the pandemic period may have negatively affected QoL and rehabilitation process in participants with IS. In the light of future studies, it may be recommended to give importance to physical activity as well as other factors in the rehabilitation of individuals with IS.

Evaluation of Self-Perceived Body Image in Adolescents with Mild Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is the most prevalent types of scoliosis, affecting up to 3% of children around the world. The progression of AIS can cause alteration in psychological components such as self-perceived body image and self-identity, which negatively affect the teenager quality of life (QoL). The mainly aim of this cross-sectional study is to investigate how mild AIS impacts self-perceived body image in young people. Fifteen participants (mean age = 14.47 ± 2.825) of both sexes (male = 5; female = 10) with a curve magnitude from 10° up to 25° completed the Scoliosis Research Society Patient Questionnaire (SRS-22), the Trunk Appearance Perception Scale (TAPS) and were subject to spinal analysis and photogrammetry. Results display statistical differences between self-perceived body image and other SRS-22 domains (Hotelling t2= 70.29; F (3,12) = 20.08; p < 0.001). Additionally, the regression model, which better explained the self-perceived variability, was fit by function/activity, pain, and mental health domains (F (4,10) = 4.39; p = 0.029; R2 = 0.545). Although AIS was not severe, it negatively affected participants self-perceived body image. More attention in AIS qualify of life is needed, and early treatments could be necessary to prevent psychological impairments self-perception related.

Cross-Cultural Adaptation and Validation of the Chinese Version of the Brace Questionnaire.

Objective: To adapt the questionnaire cross-culturally and to analyze the adaptation and validation of the Chinese version of the Brace Questionnaire (C-BrQ).Methods: The adaptation was based on the International Quality of Life Assessment Project guidelines. A total of 79 patients with AIS were included to examine the psychometric properties of the C-BrQ. The reliability was assessed using internal consistency (the Cronbach's alpha coefficient) and test–retest reliability (intraclass correlation coefficient ICC2.1, 95% CI). Floor and ceiling effects were calculated. Lin's concordance correlation coefficient (CCC, 95% CI) was used to compare the agreement between the Scoliosis Research Society-22 patient questionnaire (SRS-22) and C-BrQ.Results: There were strong correlations between each item and its corresponding domain significantly. The correlations between the C-BrQ domains and their related questions vary from moderate to strong (r = 0.311–0.933, P < 0.05). The Cronbach's was 0.891, showing good internal consistency of each domain of the BrQ, and the ICC in test–retest was 0.860 (0.8776, 0.912), which means an excellent test–retest reliability. The Lin's CCC between SRS-22 and C-BrQ was 0.773 (0.669, 0.848), showing great agreement. However, no significant floor and ceiling effects in C-BrQ was observed except the ceiling effect in school activity and bodily pain.Conclusion: BrQ was translated and cross-culturally adapted for use in China with good internal consistency and excellent test–retest reliability.

Cross-Cultural Adaptation and Validation of the Bad Sobernheim Stress Questionnaire in Iranian Adolescents with Idiopathic Scoliosis Using Thoracolumbar Orthoses.

Background:The assessment of the emotional consequences of having a spinal deformity and orthotic management in people with idiopathic scoliosis is essential. This study was aimed to translate and culturally adapt the Bad Sobernheim Stress questionnaire (BSSQ-Brace) for Iranian adolescents with idiopathic scoliosis using thoracolumbar orthoses.Materials and Methods:The BSSQ was translated into Persian according to a standard guideline. The Persian BSSQ-Brace was completed by 55 Iranian subjects with spinal deformities who agreed to participate in this research. The validity was determined by correlating the Persian BSSQ-Brace questionnaire (BrQ) and the revised Scoliosis Research Society-22 patient questionnaire (SRS-22r). To assess test-retest reliability, all participants completed the BSSQ-Brace twice, with a gap of 1-week. Intraclass Correlation Coefficient and Cronbach's alpha were measured to report reliability.Results:All population revealed items in the Persian BSSQ-Brace were easily understood, and there was no difficulty completing them. The psychometric properties of the Persian version of BSSQ-Brace demonstrated excellent test-retest reliability (interclass correlation coefficient = 0.94), excellent internal consistency (Chronbach's alpha = 0.94), and high construct validity with SRS-22r (r = 0.74).Conclusions:The Persian BSSQ-Brace is a reliable and valid instrument to assess the emotional domains in subjects wearing a spinal orthosis.

Schroth exercises improve health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients.

Background:Finding an optimal treatment strategy for adolescent idiopathic scoliosis (AIS) patients remains challenging because of its intrinsic complexity. For mild to moderate scoliosis patients with lower skeletal growth potential (Risser 3–5), most clinicians agree with observation treatment; however, the curve progression that occurs during puberty, the adolescent period, and even in adulthood, remains a challenging issue for clinicians. The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential (Risser 3–5) and moderate scoliosis (Cobb angle 20°–40°).Methods:From 2015 to 2017, data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed. Forty-three patients underwent Schroth exercise were classified as Schroth group, and 21 patients underwent observation were classified as observation group. Outcomes were measured by health-related quality of life (HRQOL) and radiographic parameters. HRQOL was assessed using the visual analog scale (VAS) scores for back, Scoliosis Research Society-22 (SRS-22) patient questionnaire. Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays. The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy. The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient (ICC). The paired t test was used to examine HRQOL and radiographic parameters. Clinical relevance between C2-C7 sagittal vertical axis (SVA) and thoracic kyphosis was analyzed using Spearman correlation.Results:In Schroth group, VAS back score, SRS-22 pain, and SRS-22 self-image domain were significantly improved from pre-treatment 3.0 ± 0.8, 3.6 ± 0.5, and 3.5 ± 0.7 to post-treatment 1.6 ± 0.6 (t = 5.578, P = 0.013), 4.0 ± 0.3 (t = −3.918, P = 0.001), and 3.7 ± 0.4 (t = −6.468, P < 0.001), respectively. No significant improvements of SRS-22 function domain (t = −2.825, P = 0.088) and mental health domain (t = −3.174, P = 0.061) were observed. The mean Cobb angle decreased from 28.9 ± 5.5° to 26.3 ± 5.2° at the final follow-up, despite no statistical significance was observed (t = 1.853, P = 0.102). The mean C2-C7 SVA value decreased from 21.7 ± 8.4 mm to 17.0 ± 8.0 mm (t = −1.224 P = 0.049) and mean T1 tilt decreased from 4.9 ± 4.2 ° to 3.5 ± 3.1° (t = 2.913, P = 0.011). No significant improvement of radiographic parameters and HRQOL were observed in observation group.Conclusions:For AIS patients with a Risser 3–5 and a Cobb angle 20°–40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS.

Reliability and validity of simplified Chinese version of the Italian spine youth quality of life questionnaire in adolescents with idiopathic scoliosis

BackgroundThe Italian Spine Youth Quality of Life (ISYQOL) questionnaire is used to evaluate health-related quality of life in adolescents with Idiopathic Scoliosis. The study aimed to undertake the process of cultural adaptation of the ISYQOL questionnaire into Simplified Chinese.MethodsTranslate from Italian into Simplified Chinese. It involved 138 adolescents whose Cobb angle ranged between 20 and 40 degrees, 50 wearing the brace and 88 not wearing the brace. Statistical analysis calculated the reliability, floor effects, and ceiling effects of the ISYQOL. After that, construct validity was measured by analyzing the ISYQOL relationship Scoliosis Research Society-22 patient Questionnaire (SRS-22).ResultsThere were no floor or ceiling effects in the ISYQOL questionnaire. Cronbach’s alpha coefficient evaluated for Internal consistency was 0.75 in the no-treated group and 0.88 in the brace-treated group. Intraclass correlation coefficients assessed with the use of the test-retest method were 0.72 in the no-treated group and 0.80 in the brace-treated group. A strong relationship exists between the ISYQOL measure and SRS-22 scores (rho = 0.62; p < 0.01), reflecting the high validity of the questionnaires. Both ISYQOL and SRS-22 scores showed no statistical difference between groups wearing and not wearing the brace (p > 0.05).ConclusionsTrans-cultural validation in Chinses language showed the reliability and validity of the ISYQOL.

Residual lumbar curvature that developed during adolescence accelerates intervertebral disc degeneration in adulthood.

To elucidate the influence of spinal deformity in adolescent idiopathic scoliosis (AIS) on lumbar intervertebral disc (IVD) degeneration in adulthood using magnetic resonance imaging (MRI). A total of 102 patients (8 men, 94 women; mean age, 31.4years) who had developed idiopathic scoliosis at the age of 10-18years and underwent preoperative lumbar spine MRI at the age of ≥ 20 were included in the study. Twenty volunteers (3 men, 17 women; mean age, 33.6years) without scoliosis were assessed as controls. We divided the adult scoliosis patients into two groups: Group A consisted of patients with lumbar modifier A, and Group BC consisted of those with modifiers B and C. IVD degeneration from L1/2 to L5/S1 was assessed by MRI. The Scoliosis Research Society-22 (SRS-22) patient questionnaire was used in the patients' clinical assessment. There were 40 patients in the Group A and 62 in the Group BC. Compared to the control groups, significant IVD degeneration was observed at L2/3 and L3/4 in Group A, and at all levels except for L5/S1 in Group BC. The proportion of degenerated IVDs patients (Grades 1c and 2) was significantly higher in Group BC than those in Group A at L3/L4 and L4/L5. Furthermore, the severity of IVD degeneration was significantly greater in the group BC than in the group A at all levels, except for L5/S1, especially in patients aged > 30years. The mean scores of all subdomains in the SRS-22 questionnaire were comparable between the two groups. Our study showed that the residual lumbar curvature from AIS may have accelerated IVD degeneration in adulthood, especially in patients aged > 30years. III.

A New Global Spinal Balance Classification Based on Individual Pelvic Anatomical Measurements in Patients With Adult Spinal Deformity.

A retrospective study. This study aims to establish a new, easy-to-implement global spinal balance (GSB) classification based on individual pelvic anatomical measurements in adult spinal deformity patients, and to validate this classification in terms of patients' quality of life (QOL). Coronal (central sacral vertical line) and sagittal (C7 sagittal vertical axis [C7 SVA]) lines are standard parameters to evaluate GSB. However, these parameters do not consider individual differences in height and physique. Therefore, a new classification to more simply evaluate GSB related to QOL would be a beneficial tool. This study included 279 patients with adult spinal deformity. The enrollment criteria included age >18 years and scoliosis >30°. GSB was evaluated based on C7 coronal vertical axis and C7 SVA, and was graded with our sagittal (Grades 1-3) and coronal classifications (Grades 1-3), where larger values represented worse GSB. In addition, total global balance classification (Grades 1-3) was also established based on both coronal and sagittal classifications. Patient self-assessment measures of health status were collected using the Scoliosis Research Society patient questionnaire (SRS-22). The relationships between responses to the SRS-22 and GSB were evaluated using partial correlation coefficients, adjusted by age. A newly described coronal classification correlated with the preoperative function (P < 0.02), pain (P = 0.001), subtotal (P < 0.001) domains in the SRS-22, whereas a newly described sagittal classification was correlated with the preoperative subtotal domain (P < 0.001). There were also significant correlations between total global balance and the preoperative function (P = 0.03) and subtotal domains (P < 0.001) in the SRS-22. We present a simple new classification for GSB that strongly correlates with QOL in patients with adult spinal deformity, thereby translating clinical data into meaningful patient outcomes and livelihoods.Level of Evidence: 4.

Correlation of Lower Instrumented Vertebra With Spinal Mobility and Health-related Quality of Life After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

This is a retrospective single-center and single-surgeon study. We investigated the correlation between lower instrumented vertebra (LIV) and spinal mobility 2 years after posterior spinal fusion with pedicle screws for adolescent idiopathic scoliosis (AIS) for optimal LIV selection. Spinal motion can become limited in scoliosis patients who undergo posterior spinal fusion. However, few reports exist on spinal mobility after posterior spinal fusion for AIS and the relationship between the LIV and mobility is unknown. We hypothesize that mobility limitation increases as the LIV is moved inferiorly. Of 72 consecutive patients who received posterior spinal fusion using pedicle screws for AIS between October 2009 and August 2015, 66 patients (5 male and 61 female, mean age: 14.9 y) were enrolled. In total, 66 patients were retrospectively reviewed after stratification according to LIV level. Follow-up rate was 91.7%. Patients were examined for the fingertip-to-floor distance (FFD) before and 2 years after surgery. FFD was measured from the tips of the middle fingers to the floor with the barefoot subject bent maximally forward and the feet together and knees straight. Clinical outcome was assessed using Scoliosis Research Society-22 patient questionnaire (SRS-22r) scores and a visual analog scale for low back pain before and at 2 years postoperatively. The median number of fused vertebrae was 9 (range: 4-15). The LIV was T11-12 in 15 patients, L1 in 11 patients, L2 in 10 patients, and L3 in 30 patients. The median decrease in FFD according to LIV at 2 years after surgery was T11-12: 0 cm, L1: 0 cm, L2: 5.5 cm, and L3: 10 cm. Thus, limited FFD became significantly more severe as the LIV was moved downwards (P<0.01). There were no significant correlations between limited FFD and SRS-22r or pain visual analog scale scores at 2 years postoperatively. FFD became significantly more restricted as the LIV was moved inferiorly but clinical results appeared unaffected by limited FFD.

Mid-term results of computer-assisted skip pedicle screw fixation for patients with Lenke type 1 and 2 adolescent idiopathic scoliosis: A minimum five-year follow-up study.

In skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS), the mid-term effects of reducing screw number on correction and clinical results are uncertain. We clarified the mid-term outcomes of this technique in patients with Lenke type 1 and 2 AIS. Thirty-four patients who underwent skip pedicle screw fixation (mean screw density: 1.35 screws) for Lenke type 1 and 2 AIS were retrospectively reviewed. The follow-up period was at least 5 years (mean follow-up period: 6.1 years), and the follow-up rate was 89.5%. Radiological parameters and clinical symptoms were evaluated before, immediately after, and at 2 years and 5 years after surgery. The mean Cobb angle of the main thoracic (MT) curve before, immediately after, at 2 years after surgery, and at the final 5-year minimum follow-up was 52.5°, 16.4°, 20.5°, and 19.4°, respectively. The Cobb angle of the MT curve was significantly improved immediately after, at 2 years after surgery, and at the final follow-up compared with that before surgery (p<0.01). The mean correction rate immediately after surgery was 69.0% and the rate of correction loss at the final follow-up was 8.3%. All Scoliosis Research Society-22 patient questionnaire (SRS-22r) sub scores 5 years after surgery were significantly improved compared with those beforehand (p<0.01). Correction using skip pedicle screw fixation in AIS was well maintained from the initial follow-up measurements to the final follow-up. The SRS-22r sub scores at the final follow-up were significantly improved over preoperative levels.

Midlife changes of health-related quality of life in adolescent idiopathic scoliosis patients who underwent spinal fusion during adolescence.

Our previous study reported a good health-related quality of life (HRQOL) in adolescent idiopathic scoliosis (AIS) patients 21years or more after surgery. The purpose of this study is to investigate midlife changes in HRQOL among AIS patients who passed further 5years from the previous survey. Subjects were 252 individuals who underwent spinal fusion for AIS between 1968 and 1988. The survey was administered twice-in 2009 and in 2014 using Scoliosis Research Society Patient Questionnaire (SRS-22). We analysed survey responses from 42 individuals (39 females, 3 males) who responded to both surveys. The average scores for each respective domain of the SRS-22 in 2009 and 2014, respectively, were: function, 4.3 and 4.2; pain, 4.3 and 4.3; self-image, 3.0 and 2.9; mental, 3.9 and 3.8; satisfaction, 3.6 and 3.5. There were no significant differences in any domain of the SRS-22 between 2009 and 2014. Comparing non-fused segments of the lumbar spine of patients with fewer than four discs remaining with patients with four discs or more remaining, SRS-22 satisfaction score decreased more in patients with fewer than four discs (change in patients with four discs or more: -0.02; change in patients with fewer than four discs: -0.38; P=0.05). Each SRS-22 subscore was similar between 2009 and 2014 surveys. Those scoliosis patients who underwent spinal fusion during adolescence had good HRQOL scores in midlife. Even after five years passed, good conditions were maintained.

Responsiveness and Minimal Important Changes of the Scoliosis Research Society-22 Patient Questionnaire in Subjects With Mild Adolescent and Moderate Adult Idiopathic Scoliosis Undergoing Multidisciplinary Rehabilitation.

Single-center, prospective study. Evaluating the responsiveness and minimal important changes (MICs) for the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) in adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AS). Despite the SRS-22 properties have been investigated in various different languages, there is still a lack of information concerning responsiveness and MIC, limiting the use of SRS-22 for clinical and research purposes. At the beginning and end of multidisciplinary rehabilitation programs, 149 subjects with mild AIS (Cobb angle <25°) and 140 subjects with moderate AS (Cobb angle <35°) completed the SRS-22. Upon completing the programs, subjects also performed the global perceived effect (GPE) scales test, which was divided to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated for all SRS-22 domains but satisfaction with management by distribution (effect size; standardized response mean) and anchor-based methods (receiver operating characteristic [ROC] curves; correlations between change scores of the SRS-22 and GPE). ROC curves were also used to compute the MICs. The effect size ranged from 1.23 to 1.50 in AIS and from 1.02 to 1.37 in AS. The standardized response mean ranged from 0.95 to 1.27 in AIS and from 0.66 to 0.90 in AS. The ROC analyses revealed the following MIC values (area under the curve; sensitivity; specificity): function, 0.70 (0.739;66;70) for AIS and 0.60 (0.842;84;76) for AS; pain, 0.70 (0.731;71;70) for AIS and 0.40 (0.817;81;70) for AS; mental health, 0.50 (0.708;83;58) for AIS and 0.55 (0.750;69;78) for AS; self-perceived image, 0.40 (0.609;79;42) for AIS and 0.60 (0.751;61;82) for AS. Correlations between change scores of the SRS-22 domains and GPE were low to moderate, ranging from -0.347 to -0.667. The SRS-22 was sensitive in detecting clinical changes in subjects with adolescent and adult scoliosis. We recommend taking the MICs provided into account when assessing patients' improvement or planning studies in these clinical contexts. 3.

Does corrective spine surgery improve the standing balance in patients with adult spinal deformity?

Background ContextThe effect of corrective spine surgery on standing stability in adult spinal deformity (ASD) has not been fully documented. PurposeTo compare pre- and postoperative standing balance and posture in patients with ASD. Study Design/SettingThis study is a prospective case series. Patient SampleStanding balance before and after corrective spine surgery was compared in 35 consecutive female patients with ASD (65.6±6.9 years, body mass index 22.3±2.7 kg/m2, Cobb angle 50.2±19.2°, C7 plumb line 9.3±5.6 cm, and pelvic incidence-lumbar lordosis mismatch 40.8±23.3°). Outcome MeasuresThe Scoliosis Research Society Patient Questionnaire, the Oswestry Disability Index, and force-plate analysis were used to evaluate the patient outcomes. Materials and MethodsWe reviewed patient charts and X-rays and compared standing balance before and after corrective spine surgery. All subjects were assessed by force-plate analysis using optical markers while standing naturally on a custom-built force platform. The spinal tilt, pelvic obliquity, pelvic tilt, and joint angle were calculated. The lower leg lean volume was obtained by whole-body dual X-ray absorptiometry to assess muscle strength. ResultsASD patients showed significant differences between the left and right sides in ground reaction force (dGRFs), hip (dHip), and knee angle (dKnee) while standing (dGRF 15.1±8.7%, dHip 7.1±6.6°, dKnee 5.9±5.5°). The recorded center-of-gravity (CoG) area was not improved after surgery, whereas the dGRF, dHip, and dKnee all decreased. The spinal tilt, pelvic obliquity, and pelvic tilt were all significantly improved after surgery. We found significant correlations between the radiographic trunk shift and the postoperative coronal CoG distance and recorded CoG area, and between the sagittal CoG distance and the age and the lean volume of the lower extremities (trunk shift R=0.33, 0.45; age R=0.32; lean volume R=0.31). ConclusionsCorrective spinal surgery improved the spinal alignment and joint angles in patients with ASD but did not improve the standing stability. A correlation found between the sagittal CoG distance and the lean volume of the lower extremities indicated the importance of the leg muscles for stability when standing, whereas a correlation found between the coronal CoG distance and trunk shift reflected the attenuated postural response in the ASD patients.

Outcomes of open staged corrective surgery in the setting of adult spinal deformity

Background ContextAdult spinal deformity (ASD) represents a constellation of complex malalignments affecting the spinal column. Corrective surgical procedures aimed at improving ASD can be equally challenging, and commonly require multiple index procedures and potential revisions before definitive management. There is a paucity of data comparing the outcomes of same-day(simultaneous [SIM]) and 2-day (staged [STA]) procedures for long spinal fusions for ASD. Using a large patient cohort with surgeon- and patient-reported outcomes will be particularly useful in determining the utility and effect of staging long spinal fusions for ASD. PurposeThis study aimed to compare intraoperative, perioperative, and 2-year outcomes of STA and SIM procedures correcting ASD. Study DesignThis is a retrospective analysis of a prospective multicenter database. Patient SampleA total of 142 patients (71 STA, 71 SIM) were included. Outcome MeasuresPrimary outcome measures were intra- and perioperative (6 weeks) complication rates. Secondary outcome measures were 2-year thoracolumbar and spinopelvic radiographic parameters, 2-year health-related quality of life (HRQoL) changes (Oswestry Disability Index [ODI] and Short Form-36 [SF-36]), and 2-year complication rates. MethodsInclusion criteria included patients with ASD ≥18 years with 6-week and 2-year follow-up. Propensity score matching identified similar patients undergoing STA or SIM long spinal fusions based on surgical invasiveness, pelvic tilt, and sagittal vertical axis (SVA). Complications, HRQoL scores (Scoliosis Research Society-22 Patient Questionnaire [SRS-22r], SF-36, ODI), and patient characteristics were compared across and within treatment groups at follow-up with analysis of variance (ANOVA) and paired t tests at three surgical stages: intraoperatively, perioperatively (6 weeks), and postoperatively (>6 weeks). ResultsA total of 142 patients were included (71 STA, 71 SIM). Matching STA and SIM groups based on degree of deformity and surgical invasiveness created two groups similar in overall correction of the surgery. Patients undergoing STA underwent more anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) procedures, whereas patients undergoing SIM had longer fusions. Charlson comorbidity index and revision status were similar between groups (p>.05). Staging procedures had significantly more complications causing reoperation (STA: 47% vs. SIM: 8%, p=.021), and had a greater number of perioperative complications requiring a return to the operating room (OR) (STA: 9.9% vs. SIM: 1.4%, p=.029). There was no difference in intraoperative complications, mortality, or perioperative infection or wound complications (p>.05) between the two procedures. At 2-year follow-up, incidence of revision surgery was higher in STA (STA: 21.1% vs. SIM: 8.5%, p=.033). ConclusionStaged spinal fusions, which add ALIFs and LLIFs to the procedure, compared with similar-correction SIM procedures, result in similar intraoperative complication incidence, but significantly higher rates of peri- and postoperative complications leading to revision. Functional outcomes, radiographic parameters, and mortality were similar. This will aid surgeons in their determination of the optimal treatment for such complex procedures.

Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: results of a randomised controlled trial.

To evaluate the effects of motor and cognitive rehabilitation on disability in adults with idiopathic scoliosis at lower risk of progression. 130 adults with idiopathic scoliosis (main curve <35°) were randomly assigned to a 20-week rehabilitation programme consisting of active self-correction, task-oriented exercises and cognitive-behavioural therapy (experimental group, 65 subjects, mean age of 51.6, females 48) or general physiotherapy consisting of active and passive mobilizations, stretching, and strengthening exercises of the spinal muscles (control group, 65 subjects, mean age of 51.7, females 46). Before, at the end, and 12months after treatment, each participant completed the Oswestry disability index (ODI) (primary outcome), the Tampa scale for kinesiophobia, the pain catastrophizing scale, a pain numerical rating scale, and the Scoliosis Research Society-22 Patient Questionnaire. Radiological (Cobb angle) and clinical deformity (angle of trunk rotation) changes were also investigated. A linear mixed model for repeated measures was used for each outcome. Significant effects of time, group, and time by group interaction were found for all outcome measures (P<0.001). After training, the primary outcome showed a clinically significant between-group change (12% points), which was preserved at follow-up. At follow-up, the radiological deformities showed a significant, although not clinically meaningful, between-group difference of 4° in favour of the experimental group. The experimental programme was superior to general physiotherapy in reducing disability of adults with idiopathic scoliosis. Motor and cognitive rehabilitation also led to improvements in dysfunctional thoughts, pain, and quality of life. Changes were maintained for at least 1year.

Complications and Unfavorable Clinical Outcomes in Obese and Overweight Patients Treated for Adult Lumbar or Thoracolumbar Scoliosis With Combined Anterior/Posterior Surgery

Combined anterior/posterior (A/P) spinal fusion with instrumentation has been used for many years in the treatment of adult thoracolumbar and lumbar (TL/L) scoliosis. However, the risk factors for complications and poor clinical outcomes with this procedure are not well known. To assess the risk factors for poor clinical outcomes in a series of adult lumbar or scoliosis patients undergoing combined A/P-instrumented spinal fusion. This study was a retrospective case series of surgically treated adult lumbar or thoracolumbar scoliosis patients. From 1998 to 2006, 57 patients with diagnoses of adult idiopathic scoliosis or degenerative TL/L scoliosis underwent combined A/P spinal instrumentation and fusion at 1 institution, performed by 1 senior author. The preoperative and postoperative outcome measurements included self-report measurements, physiological measurements, and functional measurements. A retrospective review of this patient group was performed to evaluate patient satisfaction, functional outcomes, pain, curve progression, and complications. Radiographic measurements included coronal balance, sagittal vertical axis, Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence preoperatively, immediately postoperatively, and during follow-up. In terms of risk factors, bone mineral density, body mass index, age, kyphosis, and fusion to the sacrum were reviewed. Postoperative Scoliosis Research Society Patient Questionnaire outcome scores, Oswestry Disability Index (ODI), and anterior surgical site pain (ASSP) were also evaluated. Means were compared with the Student t test and the χ test. Logistic regression analyses were used to predict the probabilities and the odds ratios (ORs) of the risk factors for poor clinical outcomes. A P-value of <0.05 with a confidence interval of 95% was considered significant. Fifty patients had adult idiopathic scoliosis, and 7 patients had degenerative scoliosis. The average age at surgery was 53.8 years (34-74 y), and the average follow-up was 4.8 years (2-11 y). Coronal correction for thoracic, thoracolumbar, and lumbosacral curves improved significantly. The degree of sagittal curve and coronal and sagittal balance were not significantly changed after surgery or at the final follow-up. ODI, the pain intensity domain of the ODI, and ASSP were significantly worse in obese and overweight patients, whereas OR time, estimated blood loss, and number of fused vertebrae were not different in the entire group (P=0.03 for ODI, P=0.002 for pain domain of ODI, and P=0.003 for ASSP). Logistic regression analyses for the risk factors of poor clinical outcomes indicated obesity and overweight as risk factors for poor clinical outcomes (OR=6.25 for ODI and 5.88 for ODI pain intensity score). A significantly higher rate of major complications occurred in this group compared to the entire group (30.4%, P=0.04). Low bone mineral density, old age, kyphosis, and fusion to the sacrum were not risk factors for poor clinical outcomes. Despite the good function scores and acceptable pain levels in most patients, the ODI scores of obese and overweight patients were worse compared to the rest of the patients in this study. Significantly worse scores on the pain intensity domain of the ODI and ASSP differences were likely caused by extensive dissection of the abdominal wall and psoas muscles and the technical difficulty of achieving an anterior approach to the thoracolumbar spine. Radiographs revealed no progression of the TL/L curves. This study indicates that obesity and overweight are potential risk factors for combined A/P-instrumented spinal fusion in patients with adult TL/L scoliosis, perhaps due to the technical difficulty of achieving an anterior approach to the thoracolumbar spine.