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Study Design: A multicenter study of changes in Scoliosis Research Society (SRS) outcome measures after surgical treatment of adolescent idiopathic scoliosis (AIS)., Objective: To evaluate changes in patient determined outcome measures between 2 and 5 years after AIS surgery., Summary of Background Data: Current surgical procedures have been shown to improve subjective measures in patients with AIS. At 2-year follow-up, AIS patients reported significant improvement in all 4 preoperative domains of the SRS questionnaire. In addition, the major Cobb angle was shown to be negatively correlated with preoperative scores in the pain, general self-image, and general function domains. Five-year SRS scores have not been evaluated previously., Methods: A multicenter, prospectively generated database was used to obtain perioperative, radiographic, and SRS-24 outcomes data. The inclusion criteria were: a diagnosis of AIS, surgical treatment (anterior, posterior, or combined), a comprehensive set of radiographic measures, and completed preoperative, 2-year, and 5-year SRS questionnaires. Repeated measures analysis of variance was used to compare changes in patient responses for each of the 7 outcome domains. Univariate analysis of variance was used to compare the change in pain score at 5 years to the level of the lowest instrumented vertebrae and surgical approach. A correlation analysis was used to determine the association between changes in any of the radiographic variables and changes in SRS scores. The data were checked for normality and equal variances, and the level of significance was set at P < 0.01., Results: Forty-nine patients (42 women, 7 men; 14.2 +/- 2.1 year old; 5.4 +/- 0.6 years follow-up) met the inclusion criteria for this study. Thirty-seven of 49 (76%) of these patients underwent an open or thoracoscopic anterior procedure. SRS-24 scores improved significantly in 3 of the 4 preoperative domains at the 2-year visit. At 5 years postop, a statistically significant decrease in the pain score (4.2 +/- 0.6 to 3.9 +/- 0.9, P = 0.003) and a trend toward worsening scores in 4 other domains was observed; however, Patient Satisfaction scores remained unchanged. Lowest instrumented vertebrae and surgical approach could not be correlated to changes in the pain score. In addition, no correlation was found between changes in any of the 21 radiographic measures evaluated and changes in SRS scores., Conclusion: There was a statistically significant increase in reported pain from 2 to 5 years after surgical treatment; however, the etiology of worsening pain scores could not be elucidated. Given continued patient satisfaction, the clinical relevance of this small reduction remains unknown. Nevertheless, this observation deserves further evaluation and must be considered in relation to the natural history of this disease.

Study Design: A retrospective review of surgical outcomes in adolescents with idiopathic scoliosis., Objective: To determine if an association exists between body mass and surgical outcomes in adolescent idiopathic scoliosis (AIS)., Summary of Background Data: Obesity has reached epidemic proportions globally. In adults, obesity increases the likelihood of developing multiple medical comorbidities and has been associated with an increased incidence of perioperative complications. The effect of obesity on surgical outcomes in the treatment of AIS patients has not been studied previously., Methods: Radiographic measures, perioperative data, and Scoliosis Research Society Outcomes scores were collected on surgically treated AIS patients. The body mass index (BMI) was calculated for each patient and normalized to sex and age (BMI %). Analysis of variance was used to identify differences between healthy weight (BMI % <85) and overweight patients (BMI % >or=85). The data were checked for normality and equal variances, and the level of significance was set at 0.01., Results: Two hundred forty-one patients (204 women, 37 men; 14.3 +/- 2.0 years) with a minimum of 2-year follow-up met the inclusion criteria for this study. The average BMI (kg/m2) was 20.7 +/- 3.7 (BMI % average: 54.5, range: 1-99). No significant differences were found between the overweight (n = 48) and healthy weight (n = 193) patients with regards to surgical time, estimated blood loss, major Cobb percent correction, maintenance of correction, rate of implant failure, pseudarthrosis, and surgical revision. However, the preoperative thoracic kyphosis was significantly greater in the overweight group (27.0 degrees +/- 12.6 degrees) compared with the healthy weight patients (21.8 degrees +/- 12.5 degrees) (P = 0.004)., Conclusion: Overweight adolescents (BMI % >or=85) had a greater thoracic kyphosis before surgery compared with their healthy weight peers. Body mass, however, did not affect the ability to achieve coronal or sagittal scoliotic deformity correction, and did not increase perioperative morbidity or mortality. These findings were either influenced by the small sample size of this cohort, or because the comorbidities responsible for increased perioperative complications in adults, had not yet developed in this adolescent population.