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Ethnic Variation in Satisfaction and Appearance Concerns in Adolescents With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion With Instrumentation

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Abstract

Study Design

Cohort analysis.

Objective

Document satisfaction with management and appearance concerns in children of different ethnicity who underwent spinal fusion/instrumentation for adolescent idiopathic scoliosis (AIS).

Summary of Background Data

Scoliosis Research Society Questionnaire (SRS-30) outcomes in AIS indicate a link between appearance and satisfaction as well as ethnic variation in appearance domain. Exploration of these findings in the Scoliosis Appearance Questionnaire (SAQ) will allow better understanding of ethnic variation in appearance concerns.

Methods

Children with AIS who underwent posterior-only operations and completed the SAQ’s question 31 were identified. Univariate logistic regression of SAQ questions 12–30 was used to assess relationships with ethnicity.

Results

1,977 children [boys: 281, girls: 1,290, unspecified: 406; average age 15.1 ± 2.0 years preoperatively and 817 children (boys: 113, girls: 569, unspecified: 135; average age 15.1 ± 2.0 years) at 2 years’ follow-up met inclusion criteria. The majority were Caucasian (57.3%). Few were Hispanic (3.4%). Preoperatively, the largest percentage of patients in each ethnic group answered “very true” to “wanting to be more even.” Preoperatively, Asians were least likely to be concerned about evenness of shoulders, hips, waist, ribs, and chest in back (p < .05); however, they expressed greatest concern about height (p < .05). African Americans and Hispanics were more likely to be concerned about breast evenness and anterior chest and looking better in clothes (p < .05). African Americans were most concerned about overall evenness and evenness of shoulders, hips, waist, ribs, posterior chest, leg length, and looking more attractive (p < .05). Surgical scar was most important postoperatively for all ethnicities. African Americans and Hispanics were more self-conscious about scar (p < .05). African Americans were most likely to want to be more even and have more even shoulders, hips, waist, leg lengths, ribs, breasts, and chest postoperatively.

Conclusions

Ethnicity influenced appearance concerns in pre- and postoperative SAQ evaluation. Ethnic variation in appearance concerns should be taken into account and differentiated when counseling patients about AIS and surgical correction.

Level of Evidence

Level III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California—San Francisco (UCSF), 500 Parnassus Avenue, MU325W, San Francisco, CA, 94143-0728, USA

    Alexander A. Theologis MD, Matthew Crawford MD & Mohammad Diab MD

Authors
  1. Alexander A. Theologis MD
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  2. Matthew Crawford MD
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  3. Mohammad Diab MD
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Spinal Deformity Study Group

Corresponding author

Correspondence to Mohammad Diab MD.

Additional information

AAT (other from Medtronic, during the conduct of the study; grants from DePuy Synthes; other from Stryker, Medtronic, and Globus, outside the submitted work); MC (other from Medtronic, during the conduct of the study); MD (other from Medtronic, during the conduct of the study; other from Fixes 4 Kids, outside the submitted work).

Funding sources included Spinal Deformity Study Group under administration of Medtronic. Relevant financial activities outside the submitted work: grants, travel accommodations, and stocks/stock options. This publication’s statistical assistance was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR000004. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Theologis, A.A., Crawford, M., Diab, M. et al. Ethnic Variation in Satisfaction and Appearance Concerns in Adolescents With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion With Instrumentation. Spine Deform 6, 148–155 (2018). https://doi.org/10.1016/j.jspd.2017.07.003

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  • DOI: https://doi.org/10.1016/j.jspd.2017.07.003

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