Journal of Pediatric Orthopaedics - 2026-01-01 - Journal Article
Perioperative Vitamin D Repletion is Associated With Improvement in SRS-22r Function Scores in Pediatric Patients With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion and Instrumentation.
Umesh A, Marsh IG, Wisch JL, Senthilnathan IS, Nian PP, Adhiyaman A, Zucker CP, Tracey OC, Murray M, Doyle SM, Widmann RF, Heyer JH
Topics
Key Takeaway
Vitamin D-deficient AIS patients undergoing PSFI had lower preoperative SRS-22r function scores (4.4 vs 4.6, P=0.020) but achieved equivalent 2-year postoperative scores after perioperative repletion.
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Summary
This study compared preoperative and 2-year postoperative SRS-22r scores between vitamin D-deficient (<30 ng/mL, n=25) and sufficient AIS patients undergoing PSFI, with deficient patients repleted using 800–2000 IU daily or 50,000 IU weekly. Deficient patients had lower baseline function scores (4.4 vs 4.6, P=0.020) but equivalent 2-year scores after repletion, with the deficient group showing improvement across four SRS-22r subdomains versus two in the sufficient group. A weak inverse relationship was found between vitamin D level and preoperative Cobb angle (β=-0.178, r=-0.35, P=0.016).
Key Limitation
The absence of a non-repleted deficient control group makes it impossible to determine whether functional improvement resulted from vitamin D repletion, surgical correction, or natural postoperative recovery.
Original Abstract
BACKGROUND
The aims of this study were to assess the differences in preoperative Scoliosis Research Society 22r (SRS-22r) questionnaire scores, two-year postoperative SRS-22r scores, and the change in SRS-22r scores from preoperatively to two years postoperatively between patients with idiopathic scoliosis (IS) undergoing spinal fusion with instrumentation (PSFI) who were vitamin D sufficient and vitamin D deficient preoperatively.
METHODS
This was a retrospective review of patients with juvenile and adolescent IS aged 11 to 20 years who underwent PSFI from 2018 to 2022 with a minimum of 2-year follow-up. Patients with vitamin D levels <30 ng/mL were considered deficient and repleted with vitamin D3 800 to 2000 international units (IU) daily or 50,000 IU weekly. Variables were compared between vitamin D deficient and sufficient groups with Wilcoxon or two‑sample t tests. Linear regression was used to assess the relationship between preoperative major curve and vitamin D levels.
RESULTS
Forty-seven patients were included. Twenty-five patients (53%) were vitamin D deficient. The mean preoperative vitamin D levels were 21±6 ng/mL in the deficient group and 41±14 ng/mL in the sufficient group ( P <0.001). Pre-operatively, vitamin D deficient patients had lower SRS‑22r function scores than sufficient patients (4.4 vs. 4.6; P =0.020), while two-year postoperative scores were similar. When comparing preoperative to postoperative subdomains, function, management, pain and self-image scores all improved in the vitamin D deficient group, while management and self-image scores improved in the vitamin D sufficient group. Linear regression demonstrated a weak inverse relationship between vitamin D levels and preoperative major curve size (β=-0.178; r=-0.35; P =0.016).
CONCLUSIONS
In patients undergoing PSFI for IS, vitamin D deficient patients had lower preoperative SRS-22r function scores compared with vitamin D sufficient patients. After perioperative repletion and PSFI, vitamin D deficient patients experienced improvement in their function score and achieved similar 2-year postoperative SRS-22r function scores compared with sufficient patients. Our findings strongly support preoperative vitamin D screening and perioperative vitamin D repletion in IS patients undergoing PSFI.
LEVEL OF EVIDENCE
Level III-retrospective case control study.