Patient-reported Outcomes Following Surgical Intervention for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

Bayan Aghdasi, Keith R. Bachmann, Desraj Clark, Rachel Koldenhoven, Mark Sultan, Jose George, Anuj Singla, Mark F. Abel

Research output: Contribution to journalArticlepeer-review

Abstract

Study Design:This was a systematic review and meta-analysis.Objective:This study aims to perform a systematic review and quantitative meta-analysis of patient-reported outcome measures after spinal fusion for adolescent idiopathic scoliosis (AIS).Summary of Background Data:Radiographic correction of scoliosis is extensively reported in the literature but there is a need to study the impact of spinal fusion on patient-reported outcome measures. Prior reviews lacked homogeneity in outcome measures, did not perform quantitative meta-analysis of pooled effect size, or interpret the results in light of minimally clinically important difference thresholds.Materials and Methods:A systematic review of medical databases identified all studies that prospectively reported Scoliosis Research Society (SRS)-22 questionnaire data after spinal fusion for AIS. We screened 2314 studies for eligibility. Studies were included that reported preoperative and postoperative data at 24- or >60-month follow-up. Studies were excluded that failed to report means and SDs which were needed to calculate Cohen d effect sizes and 95% confidence intervals in estimating the magnitude and precision of the effect.Results:A total of 7 studies met eligibility criteria for inclusion in quantitative meta-analysis of effect sizes and 95% confidence intervals. Patients report large improvements in total score, self-image, and satisfaction; and moderate improvements in pain, function and mental health at 2 and 5 years after spinal fusion for AIS. All domains showed statistically significant improvement at all times except function at >60 months. All domains surpassed the minimally clinically important difference at all times except mental health.Conclusions:Moderate evidence suggests that spinal fusion improves quality of life for adolescents with idiopathic scoliosis in medium and long-term follow-up. Our results may help inform patient expectations regarding surgery.OCEMB Level of Evidence:Level I - systematic review and meta-analysis of prospective studies.

Original languageEnglish (US)
Pages (from-to)24-34
Number of pages11
JournalClinical Spine Surgery
Volume33
Issue number1
DOIs
StatePublished - Feb 1 2020
Externally publishedYes

Keywords

  • AIS
  • SRS
  • SRS-22
  • effect size
  • meta-analysis
  • patient-reported outcome
  • scoliosis
  • spinal fusion

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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