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Quality of Life Improvement Following Surgery in Adolescent Spinal Deformity Patients: A Comparison Between Scheuermann Kyphosis and Adolescent Idiopathic Scoliosis

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Abstract

Study Design

Preoperative and two-year follow-up health-related quality of life (HRQOL) data were prospectively collected in 82 Scheuermann kyphosis (SK) and 995 adolescent idiopathic scoliosis (AIS) patients using the Scoliosis Research Society–22 patient questionnaire (SRS-22) outcomes instrument in a multicenter study. Visual analog scale (VAS) scores were also collected for the SK population.

Objectives

This study assessed changes in HRQOL prospectively and compared them to those occurring in AIS.

Summary of Background Data

There has been limited evaluation of patient-reported HRQOL changes with operative management of SK.

Methods

Median SRS values for the SK and AIS cohorts were compared using a repeated measure of analysis of variance with age as a covariate and using a Mann-Whitney U nonparametric comparison.

Results

Kyphosis was corrected from 73.9° to 45.8° (p < .001); the major curve in AIS was corrected from 55.5 to 20.2 (p < .001). Preoperative and magnitude of radiographic correction, kyphosis apex and body mass index in SK were not correlated with baseline or change in HRQOL. SK SRS scores improved after surgery in all domains with the greatest change (2.8–4.4) in self-image (p < .001). Changes in SRS Pain, Activity, and Self-Image domains met the minimal clinically important difference. Baseline SK and AIS scores differed significantly in the Self-Image, Mental Health and Total Score domains, with SK having worse scores (p < .001). At two years postoperatively, the greatest improvements were made in Self-Image, along with Mental Health and Total Score, and the SK group achieved greater gains (p < .001). At two years postoperatively, the SK scores improved to reach equivalent values to the AIS scores. VAS scores improved from 3.69 to 1.51, and these changes were correlated with change in the Pain, Mental Health, and Total Score SRS domains (p < .001).

Conclusions

Surgery for SK in the adolescent population results in significant improvements in HRQOL, which outpace those of the AIS population.

Level of Evidence

Level II.

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Author information

Authors and Affiliations

  1. New York University School of Medicine, 550 1st Avenue, 10016, New York, NY, USA

    Courtney Toombs BA

  2. Department of Orthopaedic Surgery, Mount Sinai–Beth Israel Medical Center, 1st Avenue & E 16th St, 10003, New York, NY, USA

    Baron Lonner MD

  3. Department of Orthopaedic Surgery, Nemours Children’s Clinic, Wilmington, DE, USA

    Suken Shah MD

  4. Department of Orthopaedic Surgery, Shriners Hospitals for Children, 3551 N Broad St, 19140, Philadelphia, PA, USA

    Amer Samdani MD

  5. Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, 19104, Philadelphia, PA, USA

    Patrick Cahill MD

  6. Department of Orthopaedic Surgery, Miami Children’s Hospital, 3100 SW 62nd Ave, 33155, Miami, FL, USA

    Harry Shufflebarger MD

  7. Department of Orthopaedic Surgery, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5069, 92123-4282, San Diego, CA, USA

    Burt Yaszay MD & Peter Newton MD

  8. Department of Orthopaedic Surgery, Johns Hopkins Hospital, 1800 Orleans St, 21287, Baltimore, MD, USA

    Paul Sponseller MD

Authors
  1. Courtney Toombs BA
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  2. Baron Lonner MD
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  3. Suken Shah MD
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  4. Amer Samdani MD
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  5. Patrick Cahill MD
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  6. Harry Shufflebarger MD
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  7. Burt Yaszay MD
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  8. Paul Sponseller MD
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  9. Peter Newton MD
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Corresponding author

Correspondence to Baron Lonner MD.

Additional information

Author disclosures: CT (none), BL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation, personal fees from DePuy Synthes Spine, K2M, Paradigm Spine, Spine Search, and from Ethicon; nonfinancial support from Spine Deformity Journal; grants from AO Spine, John and Marcella Fox Fund Grant, grants from OREF, outside the submitted work), SS (grants from Harms Study Group via the Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine, K2M, and NuVasive, outside the submitted work), AS (grants from DePuy Synthes Spine, during the conduct of the study; personal fees from DePuy Synthes Spine, Ethicon, Globus Medical, Misonix, Stryker, and Zimmer Biomet, outside the submitted work), PC (none), HS (grants, personal fees, and other from DePuy Synthes Spine; personal fees and other from K2M, during the conduct of the study; grants, personal fees, and other from DePuy Synthes Spine, personal fees and other from K2M, outside the submitted work), BY (grants from DePuy Synthes Spine, during the conduct of the study; grants and personal fees from DePuy Synthes, personal fees from NuVasive, grants and personal fees from K2M, personal fees from Globus, personal fees from Orthopediatrics, personal fees from Medtronic, personal fees from Stryker, outside the submitted work; in addition, BY has a patent K2M with royalties paid), PS (personal fees from DePuy Synthes Spine, from Globus, personal fees from Journal of Bone and Joint Srugery, outside the submitted work), PN (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation; other from Rady Children’s Specialists, grants and personal fees from DePuy Synthes Spine; personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna; personal fees from Law firm of Smith, Haughey, Rice & Roegge, grants from NIH, grants from OREF, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, other from NuVasive, personal fees from Ethicon Endosurgery, other from Electrocore, personal fees from Cubist, other from International Orthopedic Think Tank, other from Orthopediatrics Institutional Support, personal fees from K2M, outside the submitted work; in addition, PN has a patent “Anchoring systems and methods for correcting spinal deformities” (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) issued to DePuy Spine, Inc., a patent Screw placement guide (7981117) issued to DePuy Spine, Inc., and a patent Compressor for use in minimally invasive surgery (7189244) issued to DePuy Spine, Inc).

Funding: Grant from DePuy Spine to Setting Scoliosis Straight Foundation in support of the Harms Study Group’s research.

IRB Approval: Institutional Review Board approval was obtained for this study from the NYU Langone Medical Center IRB.

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Toombs, C., Lonner, B., Shah, S. et al. Quality of Life Improvement Following Surgery in Adolescent Spinal Deformity Patients: A Comparison Between Scheuermann Kyphosis and Adolescent Idiopathic Scoliosis. Spine Deform 6, 676–683 (2018). https://doi.org/10.1016/j.jspd.2018.04.009

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  • DOI: https://doi.org/10.1016/j.jspd.2018.04.009

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