Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up after treatment with at least 20 years brace or surgery

No results on long-term outcome in terms of health-related quality of life (HRQL) have previously been presented for patients treated for adolescent i diopathic scoliosis. A consecutive series of patients with adolescent idiop athic scoliosis, treated between 1968 and 1977 before the age of 21, either with distraction and fusion using Harrington rods [surgical treatment grou p (ST), n = 156; 145 females and 11 males] or with a brace [brace treatment group (BT), n = 127; 122 females and 5 males] were followed at least 20 ye ars after completion of the treatment. Ninety-four percent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnair e, parts of SRS/MODEM'S questionnaire and study-specific questions concerni ng the treatment, as a part or an unbiased personal follow-up examination i ncluding radiography and clinical examination. An age- and sex-matched cont rol group of 100 persons was randomly selected and subjected to the same ex aminations. The results showed no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but signif icantly, reduced physical function using the SF-36 subscales, SF-36/Physica l Component Summary (PCS) score as well as the Oswestry Disability Back Pai n Questionnaire compared to the controls. Neither the mental subscales and the Mental Component Summary (MCS) score of SF-36 nor the PGWB index showed my significant difference between the groups. Forty-nine percent of ST, 34 % of BT and 15% of controls admitted limitation of social activities due to their back [P < 0.001 ST vs controls, P = 0.0010 BT vs controls, and n.s. (P = 0.024) ST vs BT], mostly due to difficulties with physical participati on in activities or self-consciousness about appearance. Pain was a minor r eason for limitation. No correlation was found between the outcome scores a nd curve size after treatment, curve type, total treatment time or age at c ompleted treatment. Patients treated for adolescent idiopathic scoliosis we re found to have approximately the same HRQL as the general population. A m inority of the patients (4%) had a severely decreased psychological well-be ing, and a few (1.5%) were severely physically disabled due to the back.