Idiopathic Thoracolumbar Scoliosis Treated at Adult Age Timing of Surgery and Quality of Life

Abstract

Study Design. Retrospective register study. Objective. Determine when preoperative quality of life (QoL) declines in adult thoracolumbar/lumbar adolescent idiopathic scoliosis (TL/L-AIS) patients, analyze postoperative age-related changes, and assess the influence of preoperative sagittal alignment and the lowest instrumented vertebra (LIV) on QoL. Summary of Background Data. The effect of surgery on self-image, function, and pain may vary depending on age, alignment, and fusion length. Materials and Methods. A total of 310 patients were analyzed preoperatively and postoperatively until two-year follow-up. Scoliosis Research Society-22 (SRS-22) and Short Form-36 (SF-36) scores were collected. Relative spinopelvic alignment (RSA), T4 and L1 pelvic angles (T4PA-L1PA), and LIV were determined on radiographs. Linear mixed-effect regression models were used, including group, time, and interaction. Results. The phase 30 to 42 years represented an inflexion point in preoperative SRS-22 total scores, after which scores were unlikely to reach postoperative levels of younger patients. All age groups improved postoperatively. The SRS-22 total score difference at two years was -0.48 between the 40 and 60-year groups and younger-than-40-year groups (P<0.001), -0.50 between older-than-60 and younger-than-40-year groups (P<0.001). Self-image improved in all groups: +1.16 in those younger than 40 years, +1.08 in those aged 40 to 60 years, and +1.14 in those older than 60 years. Pain improved in patients aged 40 to 60 years, +0.75, and older than 60 years, +1.07. The SF-36 Physical Component Summary improvement was larger in patients aged 40 to 60 years, +6.76 (P<0.001), and older than 60 years, +8.74 (P<0.001), versus those younger than 40 years. Preoperatively, severely malaligned patients had the lowest SRS-22 and the largest postoperative improvement. Patients with LIV S1/iliac had lower SRS-22 than those with LIV L2/L3 or L4/L5 at two-year follow-up. Conclusion. In adult TL/L-AIS patients, QoL declined around the fourth life decade; postoperative recovery patterns differed. All age groups improved QoL postoperatively. Self-image improved the most. Pain and the physical component improved most in patients older than 40 years. Preoperative sagittal malalignment and the LIV influenced QoL.