Influence of age and severity of Lenke 5 or 6 idiopathic scoliosis on postoperative quality of life in adult patients

Introduction

Thoracolumbar adolescent idiopathic scoliosis can continue to progress beyond skeletal maturity. Ideal timing of surgery remains undefined. Earlier intervention, with shorter instrumentation, incurs early partial loss of lumbar motion. Waiting for progression incurs a greater risk of extensive arthrodesis. The aim of the present study was to assess the quality-of-life impact of age and scoliosis severity at surgery.

Material and methods

Patients with Lenke 5 or 6 adolescent idiopathic scoliosis, aged 16–45 years, were analyzed based on a prospective clinical registry. Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)-22 scores were collected preoperatively and at 6 months, 1 year and 2 years. Coronal and sagittal alignments were measured on full-spine radiographs, and curve flexibility was assessed on bending radiographs. A mixed linear model was used to assess the impact of age, Cobb angle and flexibility on quality of life.

Results

Thirty-six patients were included. Mean ODI was 20.5% preoperatively and 13.8% at 2 years (p = 0.017). Mean SRS-22 was 3.2 preoperatively and 3.9 at 2 years (p < 0.001). Mean Cobb angle was 56.6° preoperatively and 23.2° at 2 years (p < 0.001), with mean preoperative reducibility of 68.1%. Age and ODI correlated preoperatively (r = 0.6; p < 0.001) and at 6 months (r = 0.5; p = 0.002), as did age and SRS-22 (r = –0.6; p < 0.001 and r = –0.6; p < 0.001, respectively). Linear regression found a significant negative correlation between thoracolumbar Cobb angle and change in SRS-22 at 6 months.

Discussion

In 16–45 year-olds with Lenke 5 or 6 idiopathic scoliosis, age influenced SRS-22 score. Younger patients had better quality of life both pre- and post-operatively. Curve magnitude influenced postoperative score. The present study suggests that early surgical correction in younger patients, where instrumentation can be shorter, does not impair quality of life.

Level of evidence

IV; prospective registry study.