How Do Patients Perceive Success and Satisfaction After Vertebral Body Tethering and Fusion for Adolescent Idiopathic Scoliosis? A Qualitative Study.

Abstract

Background: Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity among children. Although posterior spinal fusion (PSF) is a commonly used treatment for curves ≥ 45°, anterior vertebral body tethering (VBT) has recently gained traction as an alternative for some patients. Surgeons have established radiographic definitions of success for PSF, with similar efforts underway for VBT. However, these definitions may not align with patient perceptions of success or their satisfaction with achieved outcomes.

Questions/purposes: To enhance patient-centered care and inform subsequent comparative effectiveness research, we asked: (1) How do patients who have undergone VBT or PSF define and perceive treatment success ≥ 3 years after surgery? (2) What are patients' perceptions of their outcomes, specifically regarding satisfaction with symptom relief, side effects, physical function, and physical appearance?

Methods: Using an approach informed by concepts from phenomenology to capture patients' lived experiences, we conducted semistructured interviews using an interview guide. Inclusion criteria required patients to have (1) progressive AIS with moderate deformity (< 60°) at surgery, (2) undergone VBT or PSF with at least 3 years of follow-up, and (3) reached full skeletal maturity. Patients unable to communicate or schedule interviews were excluded. From 96 eligible patients (VBT n = 47, PSF n = 49), we recruited 40 (20 per cohort). The sample size was guided by qualitative studies in the field and aimed to achieve saturation, defined as the point at which minimal new information and no new coding categories were identified. Participants were treated at a single urban Midwest hospital by the same physician. The VBT cohort (median age 18 years [range 16 to 22]) was 85% women/girls, while the PSF cohort (median age 21 years [range 18 to 27]) was 70% women. Interviews were analyzed using a collaborative content analysis approach in which two researchers independently identified key ideas, assigned codes, and resolved discrepancies through consensus to develop themes and subthemes aligned with the research questions.

Results: Patients from both cohorts defined success as achieving pain relief, maintaining physical function, improving appearance, ensuring long-term deformity correction, and alleviating concerns about future health risks. Patient priorities varied; some prioritized flexibility to swim competitively or play musical instruments, while others prioritized pain-free living or improved physical appearance. Overall, both groups expressed satisfaction with symptom relief, physical function, and appearance improvements despite ongoing pain, side effects, and physical limitations.

Conclusion: These findings may be used as a guide for preoperative counseling and highlight the importance of incorporating patient perspectives into preoperative counseling for AIS, emphasizing the need to set realistic expectations regarding pain relief, physical function, long-term stability, and emotional well-being. While patients frequently reported positive outcomes in pain reduction, mobility, and appearance, counseling should address potential residual discomfort, physical limitations, and body image concerns to improve satisfaction. Future research should prioritize developing nuanced, patient-centered outcome measures that capture specific priorities such as detailed pain characteristics, functional abilities, and appearance-related concerns. Comparative effectiveness studies should explore granular outcomes to provide evidence that supports shared decision-making and guides patients and clinicians in choosing between VBT and PSF based on individual goals. Additionally, examining how presurgery discussions about tradeoffs and long-term outcomes shape patient expectations and satisfaction can improve alignment between surgical practices and patient priorities.

Level of evidence: Level III, therapeutic study.