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

Retrospective register study. Determine when preoperative quality of life (QoL) declines in adult thoracolumbar/lumbar adolescent idiopathic scoliosis (TL/L-AIS) patients, analyze postoperative age-related changes, and assess the influence of preoperative sagittal alignment and the 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. A total of 310 patients were analyzed preoperatively and postoperatively until two-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), and LIV were determined on radiographs. Linear mixed-effect regression models were used, including group, time, and interaction. The phase 30 to 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 two years was -0.48 between the 40 and 60-year groups and younger-than-40-year groups ( P <0.001), -0.50 between older-than-60 and younger-than-40-year groups ( P <0.001). Self-image improved in all groups: +1.16 in those younger than 40 years, +1.08 in those aged 40 to 60 years, and +1.14 in those older than 60 years. Pain improved in patients aged 40 to 60 years, +0.75, and older than 60 years, +1.07. The SF-36 Physical Component Summary improvement was larger in patients aged 40 to 60 years, +6.76 (P<0.001), and older than 60 years, +8.74 (P<0.001), versus those younger than 40 years. Preoperatively, severely malaligned patients had the lowest SRS-22 and the largest postoperative improvement. Patients with LIV S1/iliac had lower SRS-22 than those with LIV L2/L3 or L4/L5 at two-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 the most. Pain and the physical component improved most in patients older than 40 years. Preoperative sagittal malalignment and the LIV influenced QoL.