Spine - 2026-03-20 - Journal Article
Idiopathic Thoracolumbar Scoliosis Treated at Adult Age: Timing of Surgery and Quality of Life.
Lamotte-Paulet P, Gourinchat M, Aleman C, Severac F, Núñez-Pereira S, Haddad S, Pupak A, Pellisé F, Obeid I, Boissière L, Roscop C, Alanay A, Kleinstück F, Loibl M, Pizones J, Charles YP, European Spine Study Group (ESSG)
Topics
Key Takeaway
In adult TL/L AIS patients, the 30–42 year window is the inflection point after which postoperative SRS-22 total scores remain 0.48–0.50 points lower than those achieved by patients operated on before age 40.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective register study examined age-related QoL trajectories in adult TL/L-AIS patients using SRS-22 and SF-36 with linear mixed-effect models across three age groups (<40, 40–60, >60 years). All groups improved postoperatively; however, patients operated after age 40 had SRS-22 total scores 0.48–0.50 points lower at 2 years versus the <40 group, while SF-36 Physical Component Summary gains were paradoxically larger in older cohorts (+6.76 and +8.74 vs. younger). Preoperative sagittal malalignment correlated with lowest baseline SRS-22 but largest postoperative improvement, and LIV at S1/iliac was associated with inferior 2-year SRS-22 versus LIV at L2–L5.
Key Limitation
Two-year follow-up is insufficient to assess durability of QoL gains, adjacent segment disease, or implant-related complications that disproportionately affect long fusions to the pelvis in older patients.
Original Abstract
STUDY DESIGN
Retrospective register study.
OBJECTIVE
Determine when preoperative Quality of Life (QoL) declines in adult Thoracolumbar/Lumbar Adolescent Idiopathic Scoliosis (TL/L-AIS) patients, to analyze postoperative age-related changes. Analyze the influence of preoperative sagittal alignment and Lowest Instrumented Vertebra (LIV) on QoL.
SUMMARY OF BACKGROUND DATA
The effect of surgery on self-image, function and pain may vary depending on age, alignment and fusion length.
METHODS
310 patients were analyzed preoperatively and postoperatively until 2-year follow-up. Scoliosis Research Society-22 (SRS-22) and Short Form-36 (SF-36) scores were collected. Relative Spinopelvic Alignment (RSA), T4 and L1 Pelvic Angles (T4PA-L1PA), LIV were determined on radiographs. Linear mixed-effect regression models were used including group, time, and interaction.
RESULTS
The phase 30-42 years represented an inflexion point in preoperative SRS-22 total scores, after which scores were unlikely to reach postoperative levels of younger patients. All age groups improved postoperatively. The SRS-22 total score difference at 2 years was -0.48 between 40-60 and <40-year groups (P<0.001), -0.50 between >60 and <40-year groups (P<0.001). Self-image improved in all groups: +1.16 in <40 years, +1.08 in 40-60 years, and +1.14 in >60 years. Pain improved in patients 40-60 years +0.75 and >60 years +1.07. The SF-36 Physical Component Summary improvement was larger in patients 40-60 years +6.76 (P<0.001) and >60 years +8.74 (P<0.001) versus <40 years. Preoperatively severely malaligned patients had lowest SRS-22 and largest postoperative improvement. Patients with LIV S1/iliac had lower SRS-22 than LIV L2/L3 or L4/L5 at 2-year follow-up.
CONCLUSION
In adult TL/L-AIS patients QoL declined around the fourth life decade, postoperative recovery patterns differed. All age groups improved QoL postoperatively. Self-image improved most. Pain and the physical component improved most in patients >40 years. Preoperative sagittal malalignment and the LIV influenced QoL.