Video-based assessment of functional movement quality in female adults with surgical and non-surgical scoliosis and controls: a rater-blinded observational study

Severe adult scoliosis can be surgically managed using long spinal fusion extending from the upper thoracic spine to the pelvis. However, this procedure’s long-term functional impacts remain unknown. This study aimed to evaluate movement ability and quality across five tasks among female adults with surgically managed scoliosis, non-surgically managed scoliosis, and no spinal deformity, using a dichotomous visual rating rubric developed for this study. This rater-blinded observational cohort study was conducted within a broader protocol evaluating gait and squatting biomechanics in adults with scoliosis with and without long spinal fusion. Thirty female adults were recruited into three age-matched groups: surgical ( n = 8), non-surgical ( n = 12), and control ( n = 10). Participants performed rolling, crawling, knee-walking, half-kneeling, and half-kneeling to standing, recorded from sagittal and frontal views for split-screen analysis. Surgical data were collected pre-surgery and one and/or two years post-surgery; paired comparisons included n = 7 at one year and an exploratory n = 4 at two years. Three blinded raters scored all videos twice using the final 30-criterion dichotomous rubric. Rank-based nested ANOVAs and Tukey HSD post-hoc tests assessed group and timepoint differences; raw scores were summarized descriptively. The mean age was 55.9 ± 12.1 years (range 29–73). Significant group differences occurred across all tasks (all omnibus p < 0.001). Compared to controls, participants with scoliosis showed reduced performance in knee-walking, half-kneeling, and half-kneeling to standing (all Tukey-adjusted p < 0.05). The surgical group did not demonstrate statistically significant postoperative change for rolling, crawling, or half-kneeling to standing. Greater deviation scores were observed for half-kneeling at one year ( p < 0.001). In the exploratory two-year analysis ( n = 4), greater deviation scores were observed for knee-walking and half-kneeling performance ( p < 0.001 and p = 0.007, respectively). Controls had greater rolling deviation scores than the scoliosis groups; therefore, greater rolling scores should not be interpreted straightforwardly as poorer function. Long spinal fusion may have minimal measurable effect on some movement tasks but may be associated with greater deviation scores in others, with some task-specific deficits becoming apparent only at later follow-up. The two-year findings are exploratory and hypothesis-generating. These results highlight the need for long-term follow-up and may help patients and surgeons weigh functional trade-offs when considering operative management. Larger studies are needed to validate the rubric and characterize longitudinal change.