THE IMPACT OF CURVE CORRECTION ON PATIENT SATISFACTION: IS STRAIGHTER BETTER?

The impact of curve correction on adolescent idiopathic scoliosis (AIS) patient satisfaction after posterior spinal fusion (PSF), remains unclear. To optimize correction, some surgeons may consider higher risk surgical techniques. To ensure surgical decision-making is made in the best interest of the patient, it is essential to understand the association between patient satisfaction and curve correction. The aim of this study was to determine the patient and surgical factors most related to satisfaction in AIS patients who have undergone PSF, with a particular focus on the impact of curve correction. AIS patients that had completed a pre- and postoperative Scoliosis Research Society (SRS) questionnaire a year or more after surgery were included. The mean differences between pre- and postoperative scores were assessed using paired two-sample t-tests (normally distributed) and the Wilcoxon rank sum test (not normally distributed) and considered with respect to MCID. Associations between SRS-questionnaire scores and covariates were assessed using linear regression models. Of the 95 patients included (mean age 15.1, 86.3% female), 73 had completed sufficient baseline and follow-up items to consider their total SRS score. There was no other difference between these groups. Mean percent correction was 71.7% (45.8-96.8%) and SVA was corrected by an average of -1.16cm (-7.8-6.7cm). Total and all domain SRS scores, except function, showed statistically significant improvement after PSF. Univariate regression revealed associations between complications (p=0.046) and male sex (p=0.020) with decreasing satisfaction scores, and percent correction (p=0.001) and SVA change (p=0.048) with increasing self-image scores. After multivariable adjustment, male sex was associated with reduced satisfaction scores (p=0.030) and increasing percent correction was associated with improvement in self-image scores (p=0.004), with an effect size of 0.021. No relationship between percent correction and satisfaction was found. Improvement in total score, pain, self-image, mental health and satisfaction was statistically significant however, clinical significance was exclusively achieved in pain and self-image domains. Greater correction was only associated with higher self-image scores with our results suggesting 47% correction produces meaningful improvement. These findings suggest cosmesis may be a concern for AIS patients and should be considered during preoperative planning.