The Journal of Bone and Joint Surgery (American). 2008;90:1231-1239.
doi:10.2106/JBJS.G.00114
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Long-Term Health-Related Quality of Life After Surgery for Adolescent Idiopathic Scoliosis and Spondylolisthesis

Ilkka Helenius, MD, PhD1, Ville Remes, MD, PhD2, Tommi Lamberg, MD, PhD3, Dietrich Schlenzka, MD, PhD3 and Mikko Poussa, MD, PhD3

1 Hospital for Children and Adolescents, Helsinki University Central Hospital, FIN-00029 HUS, Helsinki, Finland. E-mail address: ilkka.helenius{at}helsinki.fi
2 Peijas Hospital, Helsinki University Central Hospital, P.O. Box 900, FIN-00029, Helsinki, Finland
3 ORTON Orthopaedic Hospital, Invalid Foundation, Tenholantie 10, FIN-00280 Helsinki, Finland

Investigation performed at ORTON Orthopaedic Hospital and Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Foundation for Pediatric Research, Instrumentarium Scientific Foundation, Päivikki and Sakari Sohlberg Foundation, Emil Aaltonen Foundation, Orion Research Foundation, and Paulo Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: The aim of surgical treatment for adolescent idiopathic scoliosis is primarily to prevent progression and secondarily to correct the deformity, whereas the goal of surgical treatment of pediatric spondylolisthesis is mainly to relieve pain and, in patients with a high-grade slip, to prevent progression. The aim of this study was to compare the long-term health-related quality of life after surgery for idiopathic scoliosis and spondylolisthesis in adolescence.

Methods: One hundred and ninety patients, with a mean age of fifteen years, who were treated surgically for adolescent idiopathic scoliosis and 270 patients, with a mean age of sixteen years, who were treated surgically for low-grade or high-grade spondylolisthesis participated in the present study. The mean duration of follow-up was 14.8 years for the scoliosis group and 17.0 years for the spondylolisthesis group. Radiographs were made preoperatively, at the time of the two-year follow-up, and at the time of the final follow-up. Additionally, a physical examination was performed, and the Scoliosis Research Society-24 and Short Form-36 questionnaires were completed at the final follow-up evaluation.

Results: The median total score on the Scoliosis Research Society questionnaire was 102 (range, 63 to 118) for the scoliosis group and 95 (range, 42 to 115) for the spondylolisthesis group (p < 0.001). After adjusting for age at the time of surgery, gender, and duration of follow-up, the patients with scoliosis had a significantly higher odds ratio for a good total score (≥90 points) on the Scoliosis Research Society questionnaire than did patients with spondylolisthesis (odds ratio, 2.65 [95% confidence interval, 1.58 to 4.44]; p = 0.0002). Patients in the scoliosis group had better values for general self-image, postoperative self-image, and postoperative function than did patients in the spondylolisthesis group (p < 0.001). Sixteen patients in both groups reported that they had back pain often or very often at rest. The standardized physical component scale on the Short Form-36 yielded slightly but significantly better values for the scoliosis group (median, 53.8 points; range, 32 to 61 points) compared with the spondylolisthesis group (median, 53.4 points; range, 27 to 59 points) (p = 0.01).

Conclusions: Patients have good long-term health-related quality of life after surgery for idiopathic scoliosis and spondylolisthesis in adolescence. Patients who have surgery for idiopathic scoliosis are likely to have better long-term outcomes than are patients who have surgery for spondylolisthesis. It is possible that back pain in adolescence may affect quality of life more than spinal deformity does.


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