Scholarlink

Purpose <p>Health-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.</p> Methods <p>This 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&#xa0;years). A total of 1,539 longitudinal SRS-22r and Spinal Appearance Questionnaire (SAQ) records with up to &gt; 20&#xa0;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 <i>R</i><sup>2</sup> quantified explained variance; partial-effects plots illustrated predicted probabilities.</p> Results <p>Substantial 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&#xa0;recovery (<i>p</i> &lt; 0.01). Most postoperative HRQOL improvement occurred within the first 4&#xa0;years (SRS-22r) and 6&#xa0;years (SAQ), after which scores plateaued at normative levels with no significant long-term decline.</p> Conclusion <p>Preoperative 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.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Longitudinal patient-reported outcomes after spinal fusion for adolescent idiopathic scoliosis: recovery trajectories and insights into surgical timing

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月16日

查看全文
  • Wai-Wang Chau,
  • Alec Lik-Hang Hung,
  • Tsz-Ping Lam,
  • Jack Chun-Yiu Cheng,
  • Adam Yiu-Chung Lau

摘要

Purpose

Health-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.

Methods

This 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 R2 quantified explained variance; partial-effects plots illustrated predicted probabilities.

Results

Substantial 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.

Conclusion

Preoperative 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.