ArticleSpine deformity2026
Longitudinal patient-reported outcomes after spinal fusion for adolescent idiopathic scoliosis: recovery trajectories and insights into surgical timing.
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeHealth-related quality-of-life (HRQOL) assessment provides insight into patient's subjective experiences that complement traditional clinical and radiological indicators. This study aims to characterize individual variability in long-term HRQOL recovery trajectories after spinal fusion for severe adolescent idiopathic scoliosis (AIS) and to identify preoperative and surgical factors associated with baseline HRQOL and the rate of improvement.
methodsThis retrospective longitudinal cohort study included 388 patients with severe AIS (Cobb angle ≥ 45°) who underwent spinal fusion (mean age at surgery 15.3 ± 2.1 years). A total of 1,539 longitudinal SRS-22r and Spinal Appearance Questionnaire (SAQ) records with up to > 20 years of follow-up were analyzed. Hierarchical multilevel growth models with random intercepts and random slopes (cubic time polynomial) were used to model recovery trajectories. Preoperative patient-reported outcome measures (PROM) level, age at surgery (continuous), sex, and curve magnitude were evaluated as trajectory moderators. "Good recovery" was defined as final-visit SRS-22r composite score ≥ 4.0 or SAQ mean score ≤ 4.2. Marginal and conditional R
resultsSubstantial individual variability existed; the population-average trajectory explained only 18% of variance in SRS-22r and 23% in SAQ scores. Preoperative PROM level was the strongest moderator (additional 54-58% variance explained), with patients having moderate baseline disability showing the greatest and most rapid gains. Younger age at surgery significantly hastened recovery (p < 0.01). Most postoperative HRQOL improvement occurred within the first 4 years (SRS-22r) and 6 years (SAQ), after which scores plateaued at normative levels with no significant long-term decline.
conclusionPreoperative PROM levels and younger age at surgery are dominant, modifiable moderators of both baseline HRQOL and subsequent postoperative recovery speed. These trajectory-based findings support individualized, patient-centered surgical timing discussions rather than rigid chronological thresholds and facilitate shared decision-making that aligns postoperative HRQOL gains with key psychosocial and educational milestones.
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