Does Spinal Deformity Affect Adolescents’ Quality of Life Before We Tell Them It Should?

Background: The Scoliosis Research Society 30 Questionnaire(SRS 30) scores have been shown to correlate with major curve magnitude in preoperative patients with adolescent idiopathic scoliosis(AIS). This correlation has not been consistently demonstrable in AIS patients prior to treatment or those undergoing nonoperative treatment. We hypothesize that SRS 30 scores are dependent on knowledge of scoliosis and thus scores from new patients referred for scoliosis evaluation may not correlate with curve magnitude until after counseling by a surgeon. Among new adolescent referrals for scoliosis, we sought to determine if SRS 30 scores would be different before and after an initial visit with a surgeon, we further sought to evaluate if this effect may be different based on presenting curve magnitude or preexisting knowledge of scoliosis.

Methods: Patients ages 10-18 years referred for their first visit with an orthopaedic surgeon for a scoliosis evaluation were prospectively enrolled from 9/30/19-10/22/20. Patients were excluded if they had a prior history of AIS diagnosis and/or treatment. Patients who consented were asked to complete the SRS 30 pre and post visit. Demographic and clinical data were obtained from patient charts. A Wilcoxon signed rank test was used to analyze the pre and post visit SRS 30 scores.

Results: 52 patients participated in the study at a mean age of 14.3 years (95% CI 13.8-14.8 years), the majority of whom were White (40.4%) or Asian (23.1%), and female (71.2%), with an average Cobb angle of 23.2 degrees (95% CI 19.4-27.0 degrees). SRS 30 scores were not correlated to major curve magnitude before or after the visit. The SRS 30 Satisfaction domain exhibited a small increase post visit (pre: 3.3, post: 3.6, p=0.010) (Table 1). All other SRS 30 domains and total scores did not exhibit statistically significant differences before and after the visit. When subdivided by major curve magnitude ( <25, 25-40, >40 degrees, n= 32, 13, and 7 respectively) only the <25 group saw significant before/after differences in SRS-30 domain and total scores. The <25 group saw significant increases in Activity (pre: 4.2, post: 4.3, V=10.5, p=0.049), Satisfaction (pre: 3.5, post: 3.7, V=47.0, p=0.049), and Total score (pre: 4.2, post: 4.3, V=144.0, p=0.042) (Table 2).

Conclusion: Among new adolescent referrals for scoliosis with a wide range of presenting curve magnitudes, SRS 30 scores did not correlate to major curve magnitude. While we did observe a small increase in some domains, these were not clinically significant. Therefore, it is unlikely that counseling by a surgeon influences perceptions of quality of life in this population.