Poor outcomes and satisfaction in adolescent idiopathic scoliosis surgery: the relevance of the body mass index and self-image

Effect of clinical and radiological parameters on the quality of life in adult patients with untreated adolescent idiopathic scoliosis: a cross-sectional study

PURPOSE

The aim of this study is to evaluate the factors that affect health-related quality of life (HRQoL) in untreated adolescent idiopathic scoliosis (AIS) patients in adulthood. We investigate the effect of clinical and radiological parameters on the SRS-22 results.

METHODS

A total of 286 untreated adolescent idiopathic scoliosis patients at adult age between April 2021 and April 2022 who were admitted to our clinic were included in the study. Rotational deformities were evaluated with a scoliometer. Cobb angles, coronal balance, clavicle angle, coronal pelvic tilt, trunk shift, and apical vertebral translation were measured in standing anteroposterior X-rays. The effect of each clinical and radiological parameter on SRS-22 results was evaluated.

RESULTS

No correlation was found between gender, age, curve type, presence of gibbosity or diagnosis time, and SRS-22 scores. A negative correlation was found between the BMI of the patients and the self-image scores (r =  - 0.246, p < 0.01) and function scores (r =  - 0.193, p < 0.05). Main thoracic (MT) gibbosity negatively correlates with self-image and total SRS-22 scores. Also, negative correlations were found between lumbar/thoracolumbar (LTL) gibbosity, function, and pain scores. MT Cobb angle magnitude was negatively correlated with self-image, mental health, and total SRS-22 scores. There were negative correlations between clavicle angle and mental health score, coronal pelvic tilt and self-image score, and apical vertebral translation and pain score.

CONCLUSION

BMI, MT gibbosity, LTL gibbosity, MT Cobb angle, clavicle angle, coronal pelvic tilt, and apical vertebral translation were negatively correlated with SRS-22 domains in untreated AIS patients in adulthood.

Disordered Eating and Body Image Concerns in Young Adult Women With Scoliosis

Background

Researchers have called for more investigation into disordered eating behaviors in females with scoliosis.

Objective

The objective of the current study was to assess the associations between body image concerns, disease-specific indicators of scoliosis (ie, age of diagnosis, having undergone bracing treatment, being told by a physician your scoliosis required surgery, having a spinal fusion), quality of life, and disordered eating in a sample of young adult women diagnosed with idiopathic scoliosis during adolescence.

Design

This study was cross-sectional in design.

Methods

Participants were 177 young adult women ages 18 to 30 years diagnosed with idiopathic scoliosis by a physician who completed questionnaires online.

Results

Undergoing bracing treatment (r = -.440; P < .001), greater age at scoliosis diagnosis (r = .563; P < .001), being told scoliosis required surgery (r = -.196; P < .050), annual income (r = .306; P < .001), level of education (r = .228; P < .010), and race/ethnicity (r = -.213; P < .050) were associated with the EDE-Q Global Score. The Body Shape Questionnaire Total Score and EDE-Q Global Score (r = .848; P < .001) and EDE-Q Weight Concern Score (r = .813; P < .001) were associated. The strongest correlations between the EDE-Q and the SRS-22-Revised Subscales were generally evidenced on the SRS-22-Revised Mental Health Subscale (rs ranged from -.200 to -.371; P < .001). After controlling for annual income, highest level of education, undergoing bracing treatment, and age of scoliosis diagnosis, the Body Shape Questionnaire Total Score was significantly correlated with the EDE-Q Eating Concern Score (standardized beta coefficient = .618; P < .001).

Conclusions

These findings underscore the importance of assessing body image concerns in young adult women with scoliosis experiencing disordered eating as this information may provide valuable information relevant to treatment planning.

Effect of Body Mass Index Percentile on Clinical and Radiographic Outcome and Risk of Complications after Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis: A Retrospective Cohort Study

BACKGROUND

The aim of this study is to evaluate the effect of body mass index percentile (BMI%) at postoperative and medium follow-up in AIS patients undergoing posterior instrumented fusion (PSF).

METHODS

We analyzed 87 clinical records of patients (19 male, 68 female) who underwent PSF. The patients were divided into four groups considering BMI%: underweight (UW), normal weight (NW), overweight (OW), and obesity (OB). Demographic, clinical (SRS-22), and radiographic data were collected. The primary outcome was to assess both the surgical and clinical outcomes, whilst the secondary outcome was to compare the radiological findings among the studied groups. Follow-ups were set preoperatively, at 6 months and 5 years.

RESULTS

Our results did not show significant differences of clinical outcomes among the studied groups, except for a longer surgical time and a higher hemoglobin decrease in UW and OB patients (p = 0.007). All BMI categories showed similar radiographic outcomes, with no statistical significance at final follow-up. OB patients showed a worse percentage of major curve correction compared to baseline and to UW and OW patients.

CONCLUSIONS

The present study does not underline substantial differences in clinical and radiographic results among any of the studied groups. However, UW and OB patients showed a worse postoperative progress. Counseling should be provided for patients and families and the achievement of a normal BMI% should be recommended.

Lumbar spine coordination during axial trunk rotation in adolescents with and without right thoracic idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is a complex deformity that often leads to loss of coordination and dynamic posture. However, there is a lack of understanding on inter-segmental coordination in AIS. The purpose of this study was to compare spinal range of motion (ROM), as well as the relations to coupling angles (CA) in the spinal region during trunk rotation, between AIS and control subjects. There were 14 subjects with right thoracic AIS and 18 control subjects who participated in the study. All subjects were asked to perform five repeated axial trunk rotations in standing while holding a bar. The outcome measures included ROM at the first thoracic spinous process (T1), the seventh thoracic spinous process (T7), the twelfth thoracic spinous process (T12), and the first sacrum spinous tubercle (S1) by the motion capture system. The CA in each spinal region (trunk, lumbar spine, and lower and upper thoraces) were analyzed while considering age and body mass index (BMI). The Cobb angle demonstrated positive moderate relationships with ROM at T7 (r = 0.62, p = 0.04) and the CA in the upper thorax (r = 0.69, p = 0.02) in the AIS group. There was no CA difference at the spinous processes between groups; however, the lumbar spine ROM significantly decreased in the AIS group (t = 2.40, p = 0.02). The BMI demonstrated moderate relationships on the lumbar spine (r = -0.67, p = 0.02) in the AIS group and the lower thorax (r = 0.59, p = 0.01) in the control group. The lumbar spine was significantly dissociated in the AIS group during trunk rotation, although the Cobb angle demonstrated positive relationships with ROM at T7. Collectively, the inter-segmental CA indicated that the AIS group compensated more independently to the right thoracic convexity. MINI ABSTRACT: The coordinated trunk rotations in the adolescent idiopathic scoliosis (AIS) group were compared with the control subjects. The lumbar spine motion was dissociated with the thorax in the AIS group and was negatively correlated with body mass index. Clinicians need to consider thorax convexity and dissociated lumbar motion for compensatory and rehabilitation strategies.

Validity and responsiveness of PROMIS in adult spinal deformity: The need for a self-image domain

BACKGROUND CONTEXT

Validity and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) have been investigated in several orthopaedic subspecialties. PROMIS has shorter completion time and greater research flexibility for the heterogeneous adult spinal deformity (ASD) population versus the Oswestry Disability Index (ODI) and Scoliosis Research Society 22-item questionnaire (SRS-22r).

PURPOSE

Evaluate the validity and responsiveness of PROMIS in ASD surgery, during the early postoperative period.

DESIGN

Prospective, longitudinal study.

PATIENT SAMPLE

One hundred twenty-three patients with complete SRS-22r and PROMIS data.

OUTCOME MEASURES

Validity and responsiveness of PROMIS versus the ODI and SRS-22r.

METHODS

We identified patients who completed SRS-22r, ODI, and PROMIS questionnaires. Spearman's correlation was used to assess validity, paired-samples t tests to assess responsiveness, and Cohen's d to assess measure of effect. The authors report no conflicts of interests. No funding was received in support of this study.

RESULTS

One hundred twenty-three patients with SRS-22r and PROMIS data from the preoperative visit were included in the validity analysis. Seventy-six patients with preoperative and early postoperative (6-week to 3-month) data were included in the responsiveness analysis. The SRS-22r function, self-image, pain, and mental health scores were moderately to strongly correlated with the following PROMIS domains: physical function (r = 0.53), satisfaction with participation in social roles (r = 0.51), pain (r = -0.60), and anxiety (r = -0.73). All SRS-22r domains, PROMIS domains, and ODI scores changed significantly from preoperatively to postoperatively (p < 0.05). Compared with the SRS-22r, PROMIS showed superior responsiveness across all domains except self-image.

CONCLUSIONS

Our results indicate that PROMIS is a valid measure with comparable responsiveness to that of the SRS-22r and ODI during the early period after ASD surgery. However, a domain that reflects how ASD patients perceive their self-image should be developed and validated.

German validation of the BIDQ-S questionnaire on body image disturbance in idiopathic scoliosis

PURPOSE

The Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) is a seven-item questionnaire inquiring into patients' worries about back shape and associated problems at school, at work, with friends or family, and whether the patients are avoiding certain activities. The aim of this study was to translate the BIDQ-S into German (G-BIDQ-S), test its reliability, and establish its convergent, divergent, concurrent, and discriminant validity.

METHODS

In a prospective cohort study, 259 patients with idiopathic scoliosis (mean age 30.2; 221 female; mean Cobb angle 43.8°) completed the G-BIDQ-S; Scoliosis Research Society 22-r (SRS 22-r); Patient Health Questionnaire (PHQ-9); Positive and Negative Affect Schedule (PANAS); Questionnaire on Body Dysmorphic Symptoms (FKS); and WHO-5 Well-Being Index. Healthy control individuals matched by age, sex and BMI (n = 149; mean age 36.1; 133 female; BMI = 23.0) answered the same questions to establish discriminant validity. Discriminant statistics, and Pearson and Spearman correlations were calculated.

RESULTS

The G-BIDQ-S proved to be one-factorial, internally consistent (Cronbach alpha = 0.87), and stable over time (total score 2.22 vs. 2.21 during retest; retest reliability r = 0.79, P < 0.001). It correlated significantly with the mean SRS 22-r (r = -0.72, P < 0.001) and with Cobb angles (r = 0.30, P < 0.001)-convergent validity; much less with body mass index (r = 0.19, P < 0.001)-divergent validity; and with the PANAS (r = 0.55, P < 0.001), PHQ-9 (r = 0.53, P < 0.001), FKS (r = 0.67, P < 0.001), and WHO-5 (r = -0.54, P < 0.001)-concurrent validity. The G-BIDQ-S also showed discriminant validity, with a strong difference between the scoliosis group (total score 2.19) and the control group (total score 1.13; P < 0.001).

CONCLUSIONS

The G-BIDQ-S showed good internal consistency, reliability, and convergent, divergent, concurrent, and discriminant validity. This questionnaire is the first one inquiring into patients' body image disturbances that has been validated and is available in German.

Influence of Hindfoot Malalignment on Hallux Valgus Operative Outcomes

BACKGROUND

Hindfoot deformity has been described as a risk factor for poor hallux valgus (HV) surgery outcomes. However, there has been no study that demonstrates it. The purpose of this investigation was to evaluate the influence of hindfoot misalignment in HV surgery results.

METHODS

All patients operated on for HV during 2010 and 2011 at 3 university hospitals were included. The preoperative and 2-year postoperative radiologic data included the HV and the intermetatarsal (IM) angles, the naviculocuboid overlap (NC), the talonavicular coverage (TN) angle, the talus-first metatarsal (T-1MT) angle, as well as the calcaneal pitch (CP) angle. Additionally, the Short Form-36 questionnaire version 2.0 (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) score, satisfaction and recurrence were also analyzed. A total of 207 met the inclusion criteria. There were 26 patients (12.6%) who could not be assessed at the 2-year follow-up. Patients were allocated to a varus, normal, or a valgus hindfoot tertile using the values for the CP, NC, TN, and T-1MT angles.

RESULTS

No significant differences (P > .05) were found between the groups when the HV or IM angles, AOFAS, SF-36 Mental Composite Scale, SF-36 Physical Composite Scale, or satisfaction were compared. Similarly, no significant and strong correlations were observed (P > .05, ρ < 0.3) between any of the mentioned hindfoot measures and the outcomes scales.

CONCLUSION

No influence of hindfoot misalignment on HV surgery outcomes was found in the present study in terms of correction, pain, function, satisfaction, or quality of life. Patients with hindfoot misalignment did not obtain worse outcomes in HV surgery.

LEVEL OF EVIDENCE

Level II, prognostic, comparative study.