COMPARISION OF PRE- AND POSTOPERATIVE COSMETIC OUTCOME AFTER CORRECTION SURGERY IN PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS

Abstract

Study Design: A prospective study evaluated patients’, orthopaedists’ and not affected children of the same age ratings’ of preoperative and postoperative cosmesis in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. The cosmetic result based on a questionnaire was compared to clinical and radiological parameters. There was no correlation between the SAQ and objective clinical and radiologic parameters at all, whereas clinical and radiological parameters showed good correlation. We recommend to standardly evaluate the cosmetic outcome as after scoliosis correction surgery.

Introduction: Improving cosmesis is an important goal in scoliosis surgery. Patients’ satisfaction with the cosmetic outcome is essential in their evaluation of the surgical result. However, only few efforts were made in the past to investigate the cosmetic outcome. We performed a a prospective study evaluated patients’, orthopaedists’ and not affected children of the same age ratings’ of preoperative and postoperative cosmesis in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. The cosmetic result based on a standardized questionnaire (SAQ, spinal appearance questionnaire) was compared to clinical and radiological parameters.

Patient sample: Preoperative and postoperative photographs were taken from 32 patients (22 female, 10 male, average age 14.6 years) preoperatively and postoperatively in a standardized manner.

Materials: The photographs were assessed by use of a modified SAQ. In addition radiological measurements were performed like the cobb angles of the main curves in the coronal and sagittal plane, plumb line deviation, shoulder inequality and pelvic obliquity. The clinical investigation included the measurements of shoulder asymmetry, pelvic obliquity, rip and lumbar hump, plumb line deviation, breast asymmetry and the postoperative evaluation of the scar.

Results: The items general appearance, body shape, rib hump, and shoulder inequality of the SAQ improved most (p< 0.025). The patients judged the cosmetic result better than surgeons and healthy children (on average: 11 out 15 parameters of the SAQ improved) The surgeons came to the worst judgement (only 5 of 15 parameters improved). The interrater correlation of the surgeons was poor (ICC< 0.58). There was no correlation between the SAQ and objective clinical and radiologic parameters at all, whereas clinical and radiological parameters showed good correlation.

Conclusion: As shown in our results objective clinical and radiological parameters do not correlate with the evaluation of the cosmetic result. Therefore we recommend to establish the evaluation of the cosmetic outcome as standard investigation after scoliosis correction surgery.