BACKGROUND: Posterior spinal fusion with pedicle screws is the
gold-standard treatment for adolescent idiopathic scoliosis (AIS);
however, it is unclear whether this procedure results in improved
long-term back pain and health-related quality of life compared with
patients not surgically treated for AIS. The aim of the present study
was to evaluate back pain and quality of life in surgically managed
patients with a minimum follow-up of 5 years compared with patients with
untreated AIS and a healthy control group. METHODS: Fifty-five
consecutive adolescent patients who underwent posterior pedicle screw
instrumentation for AIS by a single orthopaedic surgeon were
prospectively enrolled. At a minimum of 5 years postoperatively, 49
patients completed Scoliosis Research Society (SRS)-24 questionnaires,
and data on reoperation were collected. Pain and quality-of-life
parameters were compared with those of 49 age and sex-matched patients
with untreated AIS and 49 healthy controls. RESULTS: The major curve
averaged 53° preoperatively and 12° at 2 years postoperatively. One
reoperation (pedicle screw removal) was needed because of a new
neurological deficit (transient). The SRS-24 pain, function, and total
scores improved significantly from preoperatively to 5 years
postoperatively (all p ≤ 0.016), with pain scores improving from 4.0 to
4.3 (p = 0.003). There was no association between pain scores and the
preoperative major curve, instrumentation below L1, or postoperative rib
hump. The surgical treatment group had significantly better pain,
activity, and self-image domain scores at 5 years postoperatively
compared with the untreated AIS group (all p ≤ 0.014), and similar pain,
self-image, and activity domain scores compared with the healthy
control group; function scores were significantly lower in the healthy
control group compared with the surgical treatment group (p < 0.001).
CONCLUSIONS: Patients who underwent posterior spinal fusion with
pedicle screws experienced improved back pain and health-related quality
of life compared with patients with untreated AIS. Patients in the
surgical treatment group had similar health-related quality of life to
that of the healthy control group, except for function, which was
significantly lower. LEVEL OF EVIDENCE: Therapeutic Level III. See
Instructions for Authors for a complete description of levels of
evidence.