European Spine Journal

, Volume 24, Issue 7, pp 1343–1355 | Cite as

Quality of life outcomes in surgically treated adult scoliosis patients: a systematic review

Review Article



The aim of this systematic review was to identify prospective studies reporting the impact of surgical intervention on health-related quality of life (HRQL) outcomes for adults with scoliosis at a minimum 2 year follow-up.


An electronic database search was conducted for January 2000–November 2013 in conjunction with a reference list search of two related systematic reviews for prospective studies of adults with scoliosis reporting HRQL outcome measure. Methodological quality of included articles was assessed using the Downs and Black checklist. Cohen’s d effect size was calculated for Scoliosis Research Society Questionnaire (SRS) and Oswestry Disability Index (ODI) outcomes for included studies and pooled data.


The database and reference list searches returned 349 potential articles; three articles met the inclusion criteria. Downs and Black scores ranged from 18/28 to 21/28 (fair–good quality evidence). Total number of 188 patients were treated surgically and had a mean age of 38 years or older. All studies showed significant improvement in reported HRQL outcomes for at least a 2 year follow-up. The Cohen’s d effect size for SRS was d = 1.4 (n = 188, 95 % CI; 0.9, 1.8) and for ODI d = 0.9 (n = 120, 95 % CI; 0.4, 1.4).


Findings from this review suggest surgery improves HRQL in patients with adult scoliosis at a minimum 2 year follow-up. However, these findings are based on limited data of fair to good quality which needs to be taken into consideration when interpreting the results and highlights the need for additional high quality prospective studies.


Adult Scoliosis Surgery Quality of life Scoliosis Research Society Oswestry Disability Index 


  1. 1.
    Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30(9):1082–1085PubMedCrossRefGoogle Scholar
  2. 2.
    Aebi M (2005) The adult scoliosis. Eur Spine J 14(10):925–948. doi:10.1007/s00586-005-1053-9 PubMedCrossRefGoogle Scholar
  3. 3.
    Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky RL (2011) Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender. Spine 36(9):731–736. doi:10.1097/BRS.0b013e3181e9f120 PubMedCrossRefGoogle Scholar
  4. 4.
    Cobb J (1948) Outline for the study of scoliosis. In: Instructional course lectures, the American Academy of Orthopaedic Surgeons (AAOS). Ann Arbor, pp 261–275Google Scholar
  5. 5.
    Buchowski JM (2009) Adult Scoliosis: etiology and classification. Semin Spine Surg 21(1):2–6. doi:10.1053/j.semss.2008.12.001 CrossRefGoogle Scholar
  6. 6.
    Tambe AD, Michael ALR (2011) (iii) Adult degenerative scoliosis. Orthop Trauma 25(6):413–424. doi:10.1016/j.mporth.2011.11.006 CrossRefGoogle Scholar
  7. 7.
    Kebaish KM (2009) Degenerative (De Novo) adult scoliosis. Semin Spine Surg 21(1):7–15. doi:10.1053/j.semss.2008.11.002 CrossRefGoogle Scholar
  8. 8.
    Palmisani M, Dema E, Cervellati S (2013) Surgical treatment of adult degenerative scoliosis. Eur Spine J 22(6):829–833. doi:10.1007/s00586-013-3012-1 PubMedCentralCrossRefGoogle Scholar
  9. 9.
    Everett CR, Patel RK (2007) A systematic literature review of nonsurgical treatment in adult scoliosis. Spine 32(19 Suppl):S130–S134. doi:10.1097/BRS.0b013e318134ea88 PubMedCrossRefGoogle Scholar
  10. 10.
    Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, Ondra S, Schwab F, Shainline M, Fu KM, Bridwell K, Spinal Deformity Study Group (2009) Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 65(1):86–93. doi:10.1227/01.NEU.0000347005.35282.6C (discussion 93–84)PubMedCrossRefGoogle Scholar
  11. 11.
    Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW Jr, Perra JH, Boachie-Adjei O, Shaffrey CI (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine 36(9):E593–E597. doi:10.1097/BRS.0b013e3182059bfd PubMedCrossRefGoogle Scholar
  12. 12.
    Coe JD, Arlet V, Donaldson W, Berven S, Hanson DS, Mudiyam R, Perra JH, Shaffrey CI (2006) Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine 31(3):345–349. doi:10.1097/01.brs.0000197188.76369.13 PubMedCrossRefGoogle Scholar
  13. 13.
    Yadla S, Maltenfort MG, Ratliff JK, Harrop JS (2010) Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus 28(3):E3. doi:10.3171/2009.12.FOCUS09254 PubMedCrossRefGoogle Scholar
  14. 14.
    Liang CZ, Li FC, Li H, Tao Y, Zhou X, Chen QX (2012) Surgery is an effective and reasonable treatment for degenerative scoliosis: a systematic review. J Int Med Res 40(2):399–405PubMedCrossRefGoogle Scholar
  15. 15.
    Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, Petticrew M, Altman DG, International Stroke Trial Collaborative Group, European Carotid Surgery Trial Collaborative Group (2003) Evaluating non-randomised intervention studies. Health Technol Assess 7(27):iii–x, 1–173Google Scholar
  17. 17.
    Saunders LD, Soomro GM, Buckingham J, Jamtvedt G, Raina P (2003) Assessing the methodological quality of nonrandomized intervention studies. West J Nurs Res 25(2):223–237PubMedCrossRefGoogle Scholar
  18. 18.
    Chudyk AM, Jutai JW, Petrella RJ, Speechley M (2009) Systematic review of hip fracture rehabilitation practices in the elderly. Arch Phys Med Rehabil 90(2):246–262. doi:10.1016/j.apmr.2008.06.036 PubMedCrossRefGoogle Scholar
  19. 19.
    Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ (2010) Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res 12(2):e23. doi:10.2196/jmir.1286 PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    SCIRE Project (2010) Quality assessment tool and data extraction. Accessed 17 November 2013
  21. 21.
    Hooper P, Jutai JW, Strong G, Russell-Minda E (2008) Age-related macular degeneration and low-vision rehabilitation: a systematic review. Can J Ophthalmol 43(2):180–187. doi:10.3129/i08-001 PubMedCrossRefGoogle Scholar
  22. 22.
    Rose PS, Lenke LG, Bridwell KH, Mulconrey DS, Cronen GA, Buchowski JM, Schwend RM, Sides BA (2009) Pedicle screw instrumentation for adult idiopathic scoliosis: an improvement over hook/hybrid fixation. Spine 34(8):852–857. doi:10.1097/BRS.0b013e31818e5962 (discussion 858)PubMedCrossRefGoogle Scholar
  23. 23.
    Lai SM, Burton DC, Asher MA, Carlson BB (2011) Converting SRS-24, SRS-23, and SRS-22 to SRS-22r: establishing conversion equations using regression modeling. Spine 36(23):E1525–E1533. doi:10.1097/BRS.0b013e3182118adf PubMedCrossRefGoogle Scholar
  24. 24.
    Becker LA (1999) Effect size calculators. University of Colorado Colorado Springs.
  25. 25.
    Neyeloff JL, Fuchs SC, Moreira LB (2012) Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 5:52. doi:10.1186/1756-0500-5-52 PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine 34(20):2171–2178. doi:10.1097/BRS.0b013e3181a8fdc8 PubMedCrossRefGoogle Scholar
  27. 27.
    Smith J, Shaffrey C, Glassman S, Carreon L, Schwab F, Lafage V, Arlet V, Fu K-M, Bridwell K (2013) Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J 22(2):402–410. doi:10.1007/s00586-012-2547-x PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Kasliwal MK, Smith JS, Shaffrey CI, Carreon LY, Glassman SD, Schwab F, Lafage V, Fu KM, Bridwell KH (2012) Does prior short-segment surgery for adult scoliosis impact perioperative complication rates and clinical outcome among patients undergoing scoliosis correction? J Neurosurg Spine 17(2):128–133. doi:10.3171/2012.4.SPINE12130 PubMedCrossRefGoogle Scholar
  29. 29.
    Glassman SD, Carreon LY, Djurasovic M, Dimar JR, Johnson JR, Puno RM, Campbell MJ (2009) Lumbar fusion outcomes stratified by specific diagnostic indication. Spine J 9(1):13–21. doi:10.1016/j.spinee.2008.08.011 PubMedCrossRefGoogle Scholar
  30. 30.
    Zimmerman RM, Mohamed AS, Skolasky RL, Robinson MD, Kebaish KM (2010) Functional outcomes and complications after primary spinal surgery for scoliosis in adults aged forty years or older: a prospective study with minimum two-year follow-up. Spine 35(20):1861–1866. doi:10.1097/BRS.0b013e3181e57827 PubMedCrossRefGoogle Scholar
  31. 31.
    Cohen J (2013) Statistical power analysis for the behavioral sciencesGoogle Scholar
  32. 32.
    McCormick JD, Werner BC, Shimer AL (2013) Patient-reported outcome measures in spine surgery. J Am Acad Orthop Surg 21:99PubMedCrossRefGoogle Scholar
  33. 33.
    Bago J, Climent JM, Perez-Grueso FJ, Pellise F (2013) Outcome instruments to assess scoliosis surgery. Eur Spine J 22(Suppl 2):S195–S202. doi:10.1007/s00586-012-2352-6 PubMedCrossRefGoogle Scholar
  34. 34.
    Bago J, Perez-Grueso FJ, Les E, Hernandez P, Pellise F (2009) Minimal important differences of the SRS-22 Patient Questionnaire following surgical treatment of idiopathic scoliosis. Eur Spine J 18(12):1898–1904. doi:10.1007/s00586-009-1066-x PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Bridwell KH, Cats-Baril W, Harrast J, Berven S, Glassman S, Farcy JP, Horton WC, Lenke LG, Baldus C, Radake T (2005) The validity of the SRS-22 instrument in an adult spinal deformity population compared with the Oswestry and SF-12: a study of response distribution, concurrent validity, internal consistency, and reliability. Spine 30(4):455–461PubMedCrossRefGoogle Scholar
  36. 36.
    Berven S, Deviren V, Demir-Deviren S, Hu SS, Bradford DS (2003) Studies in the modified scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity. Spine 28(18):2164–2169. doi:10.1097/01.BRS.0000084666.53553.D6 (discussion 2169)PubMedCrossRefGoogle Scholar
  37. 37.
    Bridwell KH, Berven S, Glassman S, Hamill C, Horton WC 3rd, Lenke LG, Schwab F, Baldus C, Shainline M (2007) Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery? Spine 32(20):2220–2225. doi:10.1097/BRS.0b013e31814cf120 PubMedCrossRefGoogle Scholar
  38. 38.
    Baldus C, Bridwell KH, Harrast J, Edwards C 2nd, Glassman S, Horton W, Lenke LG, Lowe T, Mardjetko S, Ondra S, Schwab F, Shaffrey C (2008) Age-gender matched comparison of SRS instrument scores between adult deformity and normal adults: are all SRS domains disease specific? Spine 33(20):2214–2218. doi:10.1097/BRS.0b013e31817c0466 PubMedCrossRefGoogle Scholar
  39. 39.
    Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25(22):2940–2952 (discussion 2952)PubMedCrossRefGoogle Scholar
  40. 40.
    Mehra A, Baker D, Disney S, Pynsent PB (2008) Oswestry Disability Index scoring made easy. Ann R Coll Surg Engl 90(6):497–499. doi:10.1308/003588408X300984 PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Ware JE Jr (2000) SF-36 health survey update. Spine 25(24):3130–3139PubMedCrossRefGoogle Scholar
  42. 42.
    SAGE Publications I SF-36® Health Survey. Encyclopedia of Epidemiology. SAGE Publications, Inc. SAGE Publications, Inc., Thousand Oaks, CA. doi:
  43. 43.
    Frampton CL, Hughes-Webb P (2011) The measurement of pain. Clin Oncol 23(6):381–386. doi:10.1016/j.clon.2011.04.008 CrossRefGoogle Scholar
  44. 44.
    Berven S, Deviren V, Demir-Deviren S, Hu S, Bradford D (2005) Minimal clinically important difference in adult spinal deformity: how much change is significant? In: Paper presented at the 12th International Meeting for Advanced Spine Techniques, Banff, CanadaGoogle Scholar
  45. 45.
    Durlak JA (2009) How to select, calculate, and interpret effect sizes. J Pediatr Psychol 34(9):917–928. doi:10.1093/jpepsy/jsp004 PubMedCrossRefGoogle Scholar
  46. 46.
    Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30(18):2024–2029PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Clinical and Rehabilitation Services, Faculty of Health Science and Medicine, Bond Institute of Health and SportBond UniversityRobinaAustralia
  2. 2.Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska InstitutetKarolinska University HospitalStockholmSweden
  3. 3.Department of Physical TherapyKarolinska University HospitalStockholmSweden
  4. 4.Division of Physiotherapy, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden

Personalised recommendations