Sex-Based Differences in Psychosocial Recovery Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

<b>Background:</b> Although posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) reliably improves radiographic alignment, radiological correction alone does not necessarily reflect postoperative recovery, particularly in terms of psychosocial well-being. Patient-reported outcome measures (PROMs) have become central to outcome assessment in AIS; however, the relative contributions of disease-specific and generic instruments, sex-based differences, and functional recovery, including return to sports, remain unclear. <b>Methods:</b> This prospective single-center cohort study encompassed adolescents aged 13-18 years who underwent PSF for AIS between December 2020 and November 2023. All included patients had a minimum postoperative follow-up of 24 months at the time of analysis. Health-related quality of life (HRQoL) was evaluated preoperatively and at least 2 years postoperatively using the Scoliosis Research Society-22 revised questionnaire (SRS-22r) and the Pediatric Quality of Life Inventory (PedsQL) Teen Report (ages 13-18 years). Outcomes were compared between male and female patients. Return to the preoperative level of sports was evaluated as a functional outcome. <b>Results:</b> Overall, 108 adolescents with AIS (32 males, 76 females) were included. Male patients were slightly older at the time of surgery, whereas baseline radiographic characteristics, treatment patterns, and follow-up duration were comparable between sexes. At preoperative assessment, male patients reported higher SRS-22r self-image and mental health scores compared with female patients (both <i>p</i> < 0.001). These differences were no longer present at the last follow-up (all <i>p</i> > 0.05). Emotional functioning improved significantly in both sexes (<i>p</i> < 0.001), whereas changes in pain and physical function were limited. The total PedsQL score increased significantly in female patients but not in males (<i>p</i> = 0.521). Patients across all Lenke curve types demonstrated postoperative improvements. Those with Lenke type 1 exhibited higher mean changes in SRS-22r and PedsQL total scores; however, differences in change scores between Lenke types demonstrated no statistical significance. At final follow-up, 93.5% of patients had not returned to their preoperative level of physical activity. <b>Conclusions:</b> PSF for AIS was associated with domain-specific improvements in HRQoL, predominantly reflecting psychosocial domains rather than changes in pain or physical function. Preoperative sex-based differences resolve postoperatively, and patients with Lenke curve types demonstrate improvements, with a tendency toward greater gains in Lenke type 1. Despite these improvements, return to preoperative sport levels remains restricted, indicating a gap between patient-reported recovery and functional reintegration.