Beyond the curve: long-term lived experiences and psychological outcomes of spinal fusion in adolescents with scoliosis.

Abstract

Posterior spinal fusion (PSF) surgery is the standard treatment for severe adolescent idiopathic scoliosis (AIS) and is effective in both preventing further progression of scoliosis and correcting spinal deformity. However, adolescents may face psychological and social challenges following surgery that are not captured by traditional clinical outcome measures. This study aimed to explore the long-term psychological impacts that spinal fusion surgery may have on adolescents by identifying factors, such as self-image, emotional well-being, and social functioning, that influence recovery and adjustment post-surgery. Semi-structured interviews were conducted with AIS patients who underwent PSF with primarily pedicle screw constructs with at least 10 years of follow-up. A grounded-theory approach to qualitative analysis identified key themes within each interview to structure an in-depth exploration of the patient experience after PSF. Thirteen participants completed qualitative interviews (12 female; mean follow-up: 16.5 years, range 12 - 23 years). Thematic analysis identified key domains that influenced patient experiences before and after surgical treatment, including perceived long-term success, the role of reliable support systems (such as family and medical teams), and ongoing challenges related to insecurity, limited flexibility, and activity restrictions. 12 participants reported satisfaction with their surgical care and would elect to undergo surgery again. 11 participants described an improved self-image postoperatively, though individual reasons varied. Notably, all five participants who underwent bracing prior to surgery expressed significant dissatisfaction with their bracing experience. Additionally, three of the female patients noted trouble obtaining epidurals during pregnancy as a negative side-effect of PSF surgery. Most patients who underwent PSF for AIS reported a positive experience and improved self-image post-surgery. Essential themes within this cohort include transparent communication and strong support from both families and the medical team, which promote an adolescent patient's long-term recovery and adjustment post-surgery. Understanding the themes that impact a patient's experience of PSF can inform shared decision-making and guide future research in AIS long-term outcomes. IV.