Surgery, bracing yield similar health-related quality-of-life scores in adolescent scoliosis patients

Patients treated surgically were significantly more satisfied than those treated with bracing, despite similar post-treatment Cobb angles between groups.

Conservatively managing patients with adolescent idiopathic scoliosis by bracing yields "negligible" differences in health-related quality-of-life scores compared to patients managed surgically, according to a study by researchers in the Netherlands. However, patients managed surgically appear more satisfied with their results, the study authors said.

"[The] idea that conservative treatment is preferred to surgical treatment is not supported by differences in HRQoL (health-related quality-of-life) after treatment in our adolescent patients with idiopathic scoliosis. On the contrary, patients treated with a brace were less satisfied with management results than patients treated surgically," the authors wrote.

"At the start of the 21st century with changing adolescent culture and experience, such perceptions are very important in this particular phase in a teenager's life," they noted.

Harry J. de Koning, MD, and colleagues evaluated the short-term difference in HRQoL between 45 patients treated conservatively with a Boston brace and 64 patients treated with surgery. Of the surgery patients, 31 were treated with bracing before surgery and 32 patients received surgery only, according to the study, published in the European Spine Journal.

The researchers measured HRQoL using the Scoliosis Research Society (SRS)-22 Patient Questionnaire translated into Dutch. Only data for patients with thoracic, thoracolumbar and double thoracic lumbar curves were included in the analysis to optimize the similarity between the two groups; these curves were roughly equally distributed between groups, the authors said.

The researchers found no significant correlation between baseline Cobb angles and SRS-22 scores between treatment groups.

Overall, patients with thoracolumbar curves had worse scores for function compared with those with thoracic curves (P<.05). Also, patients with thoracic lumbar curves were less satisfied with their treatment than those with thoracolumbar curves (P<.05), according to the study.

Among patients treated surgically, those with thoracic lumbar curves were less satisfied than those with thoracolumbar curves (P<.01). However, investigators saw no differences in SRS-22 scores between curve types among patients treated with bracing, the authors said.

Patients treated with bracing had significantly better mean scores for function and significantly less pain compared to those treated surgically. However, patients treated with surgery only had significantly better scores for self image/appearance compared to those treated with bracing and those treated with both bracing and surgery.

The researchers also found a "weak but significant" correlation between improvement in Cobb angle and satisfaction with treatment (P<.01). "This means that patients who improved most in Cobb angle were more satisfied with management," the authors said.

Patients treated surgically were significantly more satisfied with their management than those treated with bracing, "despite [the] Cobb angles after treatment being quite similar in both groups," they noted.

Cobb angles improved from 54° preoperatively to 32° after surgery. In contrast, patients treated with bracing had larger Cobb angles after treatment, increasing from 24° to 33° post-treatment, according to the study.

"However, this difference in satisfaction cannot only be explained by improvement of Cobb angle, since we only found a weak correlation between improvement in Cobb angle and satisfaction in the [surgery] group," the authors noted.

For more information:
Bunge EM, Juttmann RE, de Kleuver M, et al. Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment. Eur Spine J. 2007;16:83-89.