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Do postoperative radiographically verified technical success, improved cosmesis, and trunk shift corroborate with patient-reported outcomes in Lenke 1C adolescent idiopathic scoliosis?

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Abstract

Purpose

To examine correlation between postoperative radiographic and cosmetic improvements in Lenke 1C adolescent idiopathic scoliosis (AIS) with patients’ self-rated outcomes of health and disability at follow-up as determined by the Scoliosis Research Society questionnaire (SRS-30), Oswestry Disability Index score (ODI) and measure of overall health quality Euroqol-5d (EQ-5D).

Methods

24 Lenke 1C scoliosis patients, mean age 16.5 (12.8–38.1) years, treated with posterior pedicle screw-only construct, were included. The coronal profile indices (radiographic and cosmetic) regarding magnitude of spinal deformity and truncal balance were measured preoperatively, postoperatively and at final follow-up. A comprehensive index of overall back symmetry was also measured by means of the Posterior Trunk Symmetry Index (POTSI). Pearson’s correlation analysis determined the association between the radiographic–cosmetic indices and patient-rated outcomes.

Results

Mean follow-up for the cohort was 4.4 (±1.86) years. The thoracic apical vertebra-first thoracic vertebra horizontal distance (AV-TI) correction had significant correlation with function, self-image, and mental health SRS-30 scores (0.55, 0.54, 0.66). Similarly, thoracic apical vertebra horizontal translation from central sacral vertical line (AV-CSVL) correction at follow-up had significant correlation with self-image and management domains (0.57, 0.50). Follow-up POTSI correlated well with SRS-30 and EQ-5D scores (r = −0.64, −0.54). Postoperative leftward trunk shift/spinal imbalance did not influence overall cosmesis and outcomes; significant spinal realignment was evident in follow-up resulting in physiological balance and acceptable cosmesis and outcomes.

Conclusion

Significant, but less than “perfect” correlations were observed between the radiographic, cosmetic measures and patient-rated outcomes. Thoracic AV-CSVL, AV-T1 correction and POTSI associated significantly with SRS-30 scores. Whereas, thoracic Cobb angle, Cobb correction, and coronal balance did not correlate with any patient-rated outcome measure. It is, therefore, inferred that the patients-rated subjective outcomes are only poorly reflected by the objectively measured radiographic and cosmetic measures of deformity correction.

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Acknowledgments

The authors would like to offer their gratitude to Ms Pia Crone Madsen at the clinical photograph audiovisual department, Ms Lone Sand Simonsen and Ms Linda Nygaard for the follow-up of the patients. We would also like to thank Ms Linda Nygaard for her help in revising the manuscript.

Conflict of interest

This work was part of the Cost Effectiveness Spine Project (www.cespine.dk) which received support from the Danish Strategic Research Council (grant no. 2142-08-0017)

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Authors and Affiliations

  1. Department of Orthopedics E, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark

    Shallu Sharma, Cody Eric Bünger, Thomas Andersen, Haolin Sun & Ebbe Stender Hansen

  2. Indian Spinal Injuries Centre Hospital, Vasant Kunj, New Delhi, India

    Shallu Sharma

  3. Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark

    Chunsen Wu

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  1. Shallu Sharma
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  2. Cody Eric Bünger
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Correspondence to Shallu Sharma.

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Sharma, S., Bünger, C.E., Andersen, T. et al. Do postoperative radiographically verified technical success, improved cosmesis, and trunk shift corroborate with patient-reported outcomes in Lenke 1C adolescent idiopathic scoliosis?. Eur Spine J 24, 1462–1472 (2015). https://doi.org/10.1007/s00586-014-3688-x

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  • DOI: https://doi.org/10.1007/s00586-014-3688-x

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