Health-related quality-of-life in adolescent idiopathic scoliosis patients 25 years after treatment

Introduction: The purpose of this study was to evaluate the long term clinical outcomes using validated measures of health-related qualityof- life (HRQOL), 25 years after termination of scoliosis treatment, in a cohort of Adolescent Idiopathic Scoliosis Patients. Method: 219 consecutive patients treated with Boston brace (Brace) or posterior spinal fusion (PSF) using Harrington- DDT instrumentation between 1983 and 1990 at Rigshospitalet Copenhagen, were invited to participate in a long-term evaluation study. A validated Danish version of the Scoliosis Research Society 22R (SRS22R) and Short Form-36 (SF36v1) were administrated to the patients 2 weeks before the clinical and radiological examination. Results: 159 (72.6 %) patients participated in the clinical follow up and questionnaires, 11 patients participated only in the questionnaires, 8 emigrated, 4 were excluded due to progressive neurological disease and 2 were deceased. The total follow up was 170 patients (83 %), and the average follow up was 24.5 years (range 22-30 years). In the Brace group, the Cobb angel prior to treatment was 37.5degree (35.1degree-40.0degree), after treatment 34.7degree (31.9degree-37.5degree). Cobb angel after 20 years 40.2degree (36.7degree-43.6degree). In the surgical group the Cobb angel prior to treatment was 54.5degree (50.4degree-58.8degree), 1 year postoperative 29.5degree (25.7degree-33.9degree).Cobb angel after 20 years 32.35degree (27.9degree-39.5degree). 26 patients had distal segment degeneration in X-rays (16.5 %), 4 patients treated with Brace and 22 patients with posterior spinal fusion. 8 patients had proximal segment degeneration (5 %), 2 treated with brace and 6 patients with posterior spinal fusion. 4 patients were treated with posterior fusion of the distal adjacent segment (2.6 %), 1 brace pt and 3 Harrington-DDT pt. SRS22R domain scores were within the range described as normal for the general population with no statistical difference between the groups except in the Satisfaction domain, where the PSF group had better scores than the braced group. The SF36 PCS and MCS scores in both AIS cohorts were similar to the scores for the general population. Conclusion: HRQOLs, as measured by the SRS22R and SF-36, of adult AIS patients treated with Boston brace or PSF during adolescence were similar to the general population. No clinical progression of the deformity has been detected during the 25-year follow up period. The PSF group had a small but statistically significant higher score in the Satisfaction domain compared to the braced group.