Skip to main content

Table 1 Studies Evaluating Radiographic/Topographic and Treatment Indicators against Body Image and HRQL Outcomes in Adults with Scoliosis

From: The impact of patient self assessment of deformity on HRQL in adults with scoliosis

Citation

Participants

R/T/Indicator

BI/HRQL Outcome

Findings

Adult Studies

Bridwell et al [41]

56 adult patients (50 female, age range 21–60+). All prior surgical treatment. Mean Cobb angle 59.5° preoperative, 29° 2 yr postoperative

Curvature pattern, curve magnitude, treatment factors

SRS-22, SF-12, Oswestry Disability Index (ODI)

Curvature pattern: Similar rate of improvement in HRQL following surgery regardless of age/curvature pattern.

Treatment (surgery to reduce curve magnitude): pre op. to 1 year post op. = improvements in all HRQL domains except for SF-12 Mental Component Summary (MCS) and SRS-22 Function; pre op. to 2 year post op. = improvements in all HRQL domains except for SF-12 MCS; 1 year post op. to 2 year post op. = improvement in SRS-22 Pain.

The most significant improvements occurred for SRS-22 (Self Image, Total score, Pain), ODI, SF-12 Physical Component Summary (PCS), SRS Mental, and SF-12 Mental Component Summary. Older age = poorer outcomes on SF-12 PCS

Glassman et al [42]

161 matched pairs of surgically/non-surgically treated adult patients (286 female, age range 18–80). Mean Cobb angle 43° non-surgical group, 53° surgical group

Treatment type

SRS-22, SF-12, Oswestry Disability Index (ODI)

HRQL/Other symptoms: Non surgically treated group had a higher incidence of surgical risk factors (heart disease, overweight). General Health as measured by SF-12 was poorer in non surgical group. Surgical patients had a higher incidence of back/leg pain, and lower scores on the Role Physical and Bodily Pain domains of the SF-12. S urgical patients were more likely to report that the shape of their back had changed over the last 10 years and that they were very unhappy with the shape of their back. They also rated the appearance of their trunk as fair (compared to good amongst non surgical patients), and were more likely to state that their back limited personal relationships.

Deciding factors for not selecting surgery were: older age, higher Body Mass Index

Deciding factors leading to surgery were: lower SRS Self Image scores, larger thoracic curvature, greater back pain (ODI)

Glassman et al [10]

298 adult patients (84% female, age range 18–87). 126 prior surgical treatment. Curvature >30° or significant spinal deformity.

Curvature pattern, curve magnitude, coronal and sagittal balance

SRS-22, SF-12, Oswestry Disability Index (ODI)

Curvature pattern: Thoracic curvature associated with lower pain and better functioning for all patients, and better self image for surgically treated patients

Coronal balance: Coronal shift greater than 4 cm associated with poorer functioning and greater pain in non surgically treated patients.

Sagittal balance: Positive sagittal balance associated with greater pain lower function and poorer self image and social functioning.

Weinstein et al [17]

117 patients (89% female, age range 54–80 years). No surgery. Mean Cobb angle 85–90° in thoracic/thoracolumbar, 49° in lumbar curvatures.

Cobb angle, degree of apical rotation

Adapted Body Satisfaction Scale

Body satisfaction shared a low correlation with radiographic measures (r = -0.08 to -0.32). Patients reported difficulties purchasing clothes, lower physical capacity and self consciousness.

Schwab et al [18]

95 patients with AIS or degenerative scoliosis (62 female, mean age 59 years). No prior surgery. Cobb angle >15°

Radiographic indicators, pain

Visual analogue scale (VAS)

Mean Cobb angle was 28° (thoracic) and 38° (thoracolumbar/lumbar). Moderate pain reported (58 out of 100 on VAS).

Radiographic indicators: Lumbar lordosis, thoracolumbar kyphosis, L3 Endplate angle, L4 Endplate angle and Olisthy associated with pain (VAS)