Quality of life outcomes in surgically treated adult scoliosis patients: a systematic review
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.
KeywordsAdult Scoliosis Surgery Quality of life Scoliosis Research Society Oswestry Disability Index
- 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
- 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
- 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
- 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
- 20.SCIRE Project (2010) Quality assessment tool and data extraction. http://www.scireproject.com/about-scire/methods-of-systematic-review/article-assessment/quality-assessment-tool-and-data-extract. Accessed 17 November 2013
- 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
- 24.Becker LA (1999) Effect size calculators. University of Colorado Colorado Springs. http://www.uccs.edu/~lbecker/
- 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.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.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
- 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.Cohen J (2013) Statistical power analysis for the behavioral sciencesGoogle Scholar
- 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.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.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.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
- 42.SAGE Publications I SF-36® Health Survey. Encyclopedia of Epidemiology. SAGE Publications, Inc. SAGE Publications, Inc., Thousand Oaks, CA. doi:http://dx.doi.org/10.4135/9781412953948
- 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