Comparison of quality of life between operated and non-operated adults with painful degenerative scoliosis: a 2-year prospective multicentered observational study.

PURPOSE: Adult scoliosis can lead to severe impairment of quality of life. Conservative and surgical treatment are two available options to improve quality of life. Surgical treatment is effective to correct severe deformations but with significant morbidity. The comparison of the two treatments remains heterogeneous in the literature with significant cross-over to surgical treatment. The objective of the study was to compare health-related quality of life between operated and non-operated adults with painful degenerative scoliosis at 2-year follow-up.

METHODS

All patients aged between 50 to 80 years with lumbar scoliosis were prospectively included in a 2-year prospective multicentered observational study with 12 French tertiary care centers. Two groups were defined: operated group and non-operated group. Demographics, radiological parameters, surgical parameters and complications were collected. 4 clinical scores were self-reported at baseline at 1- and at 2-year follow-up and included SF-12, VAS, SRS 30 and ODI.

RESULTS

A total of 181 patients were included. Pre-treatment physical and mental components of SF-12 score were not significantly different between operated and non-operated groups with respective values of 31.2 ± 6.9 vs 34 ± 9.4 (p > 0.05) and 41.6 ± 9.5 vs 43.2 ± 13.9 (p > 0.05). Post-treatment SF-12 PCS and MCS score were not significantly different between operated and non-operated groups with respective values of 42 ± 8 vs 42 ± 9 (p = 0.65) and 46 ± 11 vs 49 ± 11 (p = 0.08). At 2 years FU, for SF-12 PCS, 41 more patients (52.5%) in operated group achieved the PASS threshold compared with pre-operative status and 19 more patients (57.6%) in non-operated group (p = 0.71). For SF-12 MCS, 40 more patients (50%) in operated group achieved the PASS threshold compared with pre-treatment status and 6 more patients (18%) in non-operated group (p = 0.002). VAS, ODI and SRS were not significantly different between the 2 groups, except function component of SRS which was higher in non-operated group (p = 0.02). Main lumbar Cobb angle correction was significantly better in operated group than in non-operated group with respective correction values of 26 ± 17° vs 4 ± 10° (p = 0.0001).

CONCLUSION

Results of our study show that both operative and non-operative treatments are associated with clinical improvement at 2-year-follow-up in adults with painful degenerative scoliosis. SF-12 PCS scores improved and did not differ between operated and non-operated groups, while SF-12 MCS scores improved and were better in operative group at 2 years. As expected, surgical treatment was effective in correcting sagittal and frontal balance.