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Surgical and brace treatments for idiopathic scoliosis improve later health-related quality of life

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Patients diagnosed with juvenile or adolescent idiopathic scoliosis have similar quality of life outcomes whether they are treated with a brace or surgery, new research reveals.

A cross-sectional study of 1,187 Swedish patients with scoliosis looked at patient-reported health-related quality of life (HRQOL) outcomes at an average follow-up of approximately 18 years.

Using the Scoliosis Research Society-22r (SRS-22r) and the EuroQol 5-Dimensions (EQ-5D) tools, the authors analysed outcomes among those who had been untreated (347), brace-treated (459), or surgically treated (381) in accordance with standards at the time of diagnosis.

The findings — published in the Journal of Bone & Joint Surgery — show that untreated adults with idiopathic scoliosis had similar health-related quality of life to previously brace-treated individuals, and they had marginally higher health-related quality of life compared with surgically treated individuals.

However, as Dr Daniel J. Sucato notes in a related commentary, “the brace and surgical groups had treatments that were current at the time but not relevant today, especially as they involved the use of first-generation techniques and instrumentation.”

According to the study authors, both surgical and brace treatments for idiopathic scoliosis could be considered successful from a health-related quality of life point of view in adulthood.

The research also revealed that the age of onset of idiopathic scoliosis does not seem to influence quality of life in adulthood.

Study co-author Dr Elias Diarbakerli, from the Department of Orthopaedics at Karolinska University Hospital in Stockholm, Sweden, told Orthopedics This Week: “The results of particular interest are that 1) onset of idiopathic scoliosis (i.e., juvenile or adolescent) does not affect quality of life outcomes; 2) surgically treated individuals with fusion in the lower lumbar spine have significantly decreased quality of life outcomes; and 3) surgically treated individuals are significantly more satisfied with their treatment (despite scoring lower on many quality of life outcomes) than their braced peers.”

Dr Diarbakerli added: “For surgeons, it is important to assess the need of extending fusion to the lower lumbar spine. Previous studies, confirmed by our findings, shows that quality of life in adulthood is negatively affected when fusion is extended in the lower lumbar spine.”

“For all clinicians managing idiopathic scoliosis, it is good to be aware of the overall similarity in quality of life outcomes between treatment groups at long-term.”