Introduction: Appearance is recognized as a pivotal issue in the management of adolescent idiopathic scoliosis, whereas pain and disability are considered the primary drivers for adult deformity surgery. However, a recent study showed that appearance was an important consideration in surgical decision making for adult scoliosis as well. The purpose of this study is to determine whether appearance, or change in appearance, significantly affect HRQOL after adult scoliosis surgery.
Methods: Prospectively collected data from 188 adult scoliosis patients (88% females, mean age = 49.7 years) enrolled in a prospective multi‐center database for adult spinal deformity were reviewed. SRS‐22, SF‐12, and ODI were assessed on the basis of net mean change from baseline to two years post‐treatment. At baseline, associations between the SRS‐22 Appearance score and responses to the Appearance questions (Questions 4, 6, 10, 14 and 19) was evaluated. Associations between baseline SRS‐22 Appearance scores, SF‐12 PCS, ODI and radiographic parameters were also analyzed. At two years, associations between change in SRS‐22 Appearance score and change in HRQOL, two‐year SRS Satisfaction score and radiographic parameters were evaluated.
Results: At baseline, all SRS‐22 Appearance questions except “appearance in clothes” correlated well with the overall domain score. There was a small degree of correlation between SRS Appearance and SF‐12 PCS (0.344), ODI (‐0.346), sagittal balance (‐0.232) and curve magnitude (‐0.215). There was no correlation between coronal balance and curve type. At two years post‐op, there was a low correlation between change in SRS‐22 Appearance and change in SF‐12 PCS (0.265) and change in ODI (0.269). Change in curve magnitude correlated with change in SRS‐22 Appearance (0.242), but the correlation was small.
Conclusion: While prior studies of adult scoliosis patients have indicated that appearance is an important factor in their decision to undergo scoliosis surgery, change in appearance appears to make a relatively minor contribution to their post‐surgical HRQOL outcomes. Concern regarding appearance should be regarded with caution as a primary indication for surgery in adult scoliosis patients.