Self-Image Perception as a Key Determinant of Long-Term Patient Satisfaction Following Adult Spinal Deformity Surgery

Study DesignRetrospective study.ObjectiveThis study aimed to identify the key determinants of long-term patient satisfaction after adult spinal deformity (ASD) surgery.MethodsData of 393 patients who underwent long-segment fusion for ASD were retrospectively analyzed. Patients were classified into the highly satisfied (HS) and less satisfied (LS) groups based on the mean satisfaction scores of the Scoliosis Research Society-22 (SRS-22) questionnaire at the final follow-up. Demographic data, surgical variables, radiographic parameters, mechanical complications, and clinical outcomes were compared between groups. Multivariate logistic regression analysis was used to identify the independent predictors of high satisfaction.ResultsThe LS and HS groups comprised 31.0% and 69.0% of the cohort, respectively. The mean follow-up duration was 36.7 months. No significant differences were found in patient demographics, surgical factors, or 6-week radiographic parameters between groups. However, at the final follow-up, the LS group exhibited a significantly greater thoracic kyphosis (<i>P</i> = .038), greater sagittal vertical axis (<i>P</i> = .013) and a higher revision rate (<i>P</i> = .022) than the HS group. All patient-reported outcomes were significantly better in the HS group than in the LS group. Multivariate analysis identified the final SRS-22 self-image score as the only independent predictor of high satisfaction (odds ratio = 6.982, <i>P</i> = .001). The calculated cutoff value of the self-image score for predicting high satisfaction was 3.0.ConclusionSelf-image perception at the final follow-up was the most significant factor influencing patient satisfaction after ASD surgery. Therefore, global sagittal alignment should be pertinently achieved and maintained to optimize patient satisfaction.