Introduction: The SRS-22 questionnaire is a disease specific instrument developed to assess the effect of idiopathic scoliosis on the patient from their vantage point. This study is being conducted to determine the responsiveness of the SRS-22 questionnaire to patient change associated with surgery.

Material and methods: This is a prospective study of surgically treated patients. The SRS-22 outcomes questionnaire consists of five domains: Pain; self image; function; mental health and satisfaction with management/surgery. There are five questions in each of the first four domains and two in the last. The scoring scale is 5 best and 1 lowest. Patients were tested pre-operatively and then at 3, 6 and 12 months post-operatively. Statistical analysis was done using the paired t-test. Comparisons were only performed on individuals with domain scores at the follow-up interval being tested. There were 33 patients (6 male and 27 female) average age 15.7 years with average Cobb size of 64°.

Results: Self image was significantly improved at three months and remained improved; Pre-operative 3.3; 3 months 4.2 p< 0.0001); 6 months 4.0 (p=0.079); and 12 months 4.2 (p> 0.0425). Function was significantly decreased at three months but returned to baseline at 6 and 12 months: Pre-operative 3.9; 3 months post-operative 3.3 (p=0.0024); 6 months 3.8 (ns) and 12 months 4.0 (ns). Surprisingly pain did not show significant change being 3.9 pre-operatively; 3.6 at 3 months; 3.5 at 6 months, and 4.1 at 12 months.

Conclusion: Based on these very preliminary data the SRS-22 questionnaire has been found to be responsive to self image and function changes in the post-surgical period. The function change was anticipated. The self image improvement occurred earlier than had been anticipated. The questionnaire was not responsive to pain change and did not reflect the substantial pain the patients had gone through at the time of the surgery. As anticipated the mental health domain was unchanged overall.

Introduction: It is now well recognised that the patient’s perception of the medical problem and the treatment for the medical problem are not always the same as the facts of the diagnosis and treatment process. The study being reported was conducted to determine the validity of the SRS-22 patient questionnaire for the discrimination of scoliosis patients based on curve pattern and curve size.

Materials: Three study groups were developed. The first or control group consisted of patients who had been referred for evaluation of suspected scoliosis but documented by X-ray not to have structural scoliosis of 10° or more. The second group, a non surgical group (NS) consisted of patients with documented idiopathic scoliosis who were either being evaluated and discharged, observed either short or long term, or who had been or would be braced. The third or surgical group (S) were being seen prior to primary idiopathic scoliosis surgery. Patients with comorbidities were excluded.

Methods: Deformity pattern and Cobb measurement were determined from standing frontal and sagittal plane radiographs. Each patient completed a SRS-22 outcomes questionnaire leaving off the satisfaction with management domain. Thus there were four domains: pain; self image; function; and mental health, five questions per domain. Scoring is 5 best and 1 lowest. Case series: Patients were gathered between October 1999 and September 2000. The control group consisted of 17 patients average age 13 years. Non surgical group included 72 patients of average age 16 years and average scoliosis of 33°. The surgical group consisted of 33 patients of average age 16 years with an average curve size of 64°.

Statistical analysis: The effect of curve pattern was studied with ANOVA and the effect of curve size by the Pearson correlation coefficient.

Results: There were 69 patients with single, 33 with double and three with triple curves. There was no difference in SRS domain or total scores based on curve pattern. There was a very significant correlation between curve size and SRS-22 score, p> 0.001 for pain; self image, function; and a total of these domains. For mental health there was also a significant relationship at p=0.0124.

Conclusion: The SRS-22 questionnaire successfully discriminates among persons with no scoliosis, moderate scoliosis, and large scoliosis by curve size. It does not discriminate among patients with single, double or triple curves.

Introduction: Spine and trunk deformity are different; trunk deformity is probably more important to the patient, and trunk deformity has received much less attention. This study was designed to determine the extent and stability of trunk deformity correction and is part of an ongoing effort to study trunk deformity.

Material and methods: This is a prospective case series the inclusion criteria being pre-, post- and follow-up surface topography evaluation of idiopathic scoliosis patients undergoing posterior instrumentation and arthrodesis. Twenty-eight patients (25 female, 3 male) met these inclusion criteria. The average age at surgery was 15 years 3 months (11 years 3 months – 38 years 2 months). Spine deformity measurement and classification were done from standing 36” PA and lateral scoliosis radiographs. Trunk asymmetry was determined from standing posterior rastersterography. Coronal plane asymmetry was calculated utilising the Posterior Trunk Symmetry Index (POTSI), threshold for change being ±8. Transverse plane asymmetry was determined by the Suzuki Hump Sum (SHS), threshold for change being ±3.5. Curve classification and number in each category were King Moe I – three; IIA – two; IIB – three; III – ten; IV – four;V – five and Triple – one. Initial follow-up averaged 2.3 months (±7) and latest follow-up 15.8 months (±8.1).

Results: Pre-operative; post-operative; and 1atest follow-up spine deformity measurements with percent correction (for spine and trunk deformity) were as follows: Major scoliosis-63°, 19° (69%) and 21° (66%); POTSI 52, 26 (50%), and 24 (54%); and SHS 18, 11 (38%), and 12 (37%). Thus, spine deformity (Cobb) and trunk deformity (POTSI and SHS) correction appeared to be stable over the follow-up period. Spine deformity correction was better than coronal trunk plane asymmetry correction which was better than transverse plane asymmetry correction. At latest follow-up, spine deformity correction for single curves was similar to multiple curve, 69% versus 64% as was transverse plane trunk asymmetry correction 34% versus 37%. However, coronal plane trunk asymmetry correction was better for single curves than double curves 63% versus 42%. At follow-up POTSI was better in all patients with single curves whereas in double curves it was better in nine, same in three, and worse in two. Transverse plane trunk asymmetry for single curves was better in ten, same in three, and worse in one, whereas for double curves it was better in eight, same in four and worse in two.

Discussion and conclusion: The obvious weaknesses in this study are the small numbers and relative short follow-up. However, the trend seems clear. Trunk deformity correction is not as good as spine deformity correction. This is especially true for the transverse plane for all curves and the coronal plane for double curves in comparison to single curves.