Comparative long-term quality of life outcomes in adolescent idiopathic scoliosis: a meta-analysis of surgical, conservative, and observation-based strategies.

Abstract

Adolescent idiopathic scoliosis (AIS) affects physical and psychosocial health, with treatments including surgery, bracing, and observation. However, the long-term effects on health-related quality of life (HRQoL) are still uncertain. The aim of the present study was to evaluate the long-term HRQoL outcomes in untreated AIS patients compared to those undergoing surgical or brace interventions through systematic review and meta-analysis. A systematic search was conducted across multiple databases (PubMed, Scopus, WoS, and Medline). Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) tool, and evidence certainty was evaluated using the GRADE system. The primary outcomes of the meta-analysis were measured using SRS-22r and SF-12 scales for the assessment of HRQoL, evaluating domains including function, mental health, pain, self-image, and satisfaction after a minimum ten-year follow-up period. Eight studies published between 2010 and 2023 that assessed HRQoL after a follow-up period of ten years or more were included in the systematic review. Six studies were included in the meta-analysis. The observation group showed better outcomes in functional (MD 0.43, 95% CI 0.01-0.84) and mental health domains (MD 0.12, 95% CI 0.03-0.20) compared to the surgical group. No significant differences were found in pain, self-image, and satisfaction domains. Comparison between observation and brace groups showed equivalence across all domains. Evidence certainty ranged from moderate to low. Long-term HRQoL in AIS shows no clear benefit of surgery or bracing over observation, which may offer equal or better mental and functional outcomes. This supports personalized care. Further high-quality research is needed to strengthen the evidence base.