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

Abstract

Retrospective register study. Determine when preoperative Quality of Life (QoL) declines in adult Thoracolumbar/Lumbar Adolescent Idiopathic Scoliosis (TL/L-AIS) patients, to analyze postoperative age-related changes. Analyze the influence of preoperative sagittal alignment and Lowest Instrumented Vertebra (LIV) on QoL. The effect of surgery on self-image, function and pain may vary depending on age, alignment and fusion length. 310 patients were analyzed preoperatively and postoperatively until 2-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), LIV were determined on radiographs. Linear mixed-effect regression models were used including group, time, and interaction. The phase 30-42 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 2 years was -0.48 between 40-60 and <40-year groups (P<0.001), -0.50 between >60 and <40-year groups (P<0.001). Self-image improved in all groups: +1.16 in <40 years, +1.08 in 40-60 years, and +1.14 in >60 years. Pain improved in patients 40-60 years +0.75 and >60 years +1.07. The SF-36 Physical Component Summary improvement was larger in patients 40-60 years +6.76 (P<0.001) and >60 years +8.74 (P<0.001) versus <40 years. Preoperatively severely malaligned patients had lowest SRS-22 and largest postoperative improvement. Patients with LIV S1/iliac had lower SRS-22 than LIV L2/L3 or L4/L5 at 2-year follow-up. 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 most. Pain and the physical component improved most in patients >40 years. Preoperative sagittal malalignment and the LIV influenced QoL.