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Background <p>Adolescent idiopathic scoliosis (AIS) affects 1–3% of children in the United States, with approximately 38,000 patients undergoing posterior spinal fusion (PSF) annually. The relationship between preoperative patient-reported outcomes, postoperative recovery, and long-term clinical significance remains unclear. This study assesses longitudinal changes in Scoliosis Research Society-22r (SRS-22r) scores. It evaluates clinical significance using the Minimum Clinically Important Difference (MCID) in AIS patients undergoing PSF.</p> Study design <p>Retrospective study using prospectively collected data.</p> Methods <p>A retrospective study was conducted using prospectively collected data on AIS patients who underwent PSF at a single academic institution between 2012 and 2022. Patient-reported outcomes were assessed using the SRS-22r questionnaire at preoperative, 6-month, 1-year, and ≥ 2&#xa0;years postoperative time points. MCID threshold achievements were determined using anchor-based criteria from Bago et al. The percentage of patients achieving MCID and predictors of MCID achievement were analyzed using logistic regression.</p> Results <p>A total of 161 patients (mean age 15.26 ± 2.15&#xa0;years; 65.8% female) were included. At 1&#xa0;year, MCID achievement ranged from 30.1% (Self-Image) to 43.4% (Mental Health). By ≥ 2&#xa0;years, MCID rates declined in Pain (25.9%) and Self-Image (22.8%) but increased in Function/Activity (44.1%). Lower preoperative SRS-22r scores consistently predicted MCID achievement across all domains. A documented mental-health history reduced the likelihood of Pain MCID at 1&#xa0;year, and larger postoperative Cobb angles independently decreased the odds of achieving Self-Image MCID at both follow-up points. Neighborhood opportunity (Child Opportunity Index) was not associated with outcomes. Sensitivity analyses demonstrated that complete-case ≥ 2 year MCID rates were consistently bounded by best- and worst-case values and closely approximated LOCF estimates, supporting robustness despite attrition.</p> Conclusion <p>Meaningful postoperative improvement after PSF varies substantially by SRS-22r domain. Pain and mental-health gains occurred early and stabilized, whereas function demonstrated ongoing recovery, and self-image improved rapidly and remained stable. MCID achievement was most likely in patients with greater preoperative symptom burden, while mental-health history and residual postoperative deformity diminished domain-specific improvements. The stability of MCID patterns across sensitivity analyses reinforces the reliability of long-term findings. These results highlight the importance of incorporating psychological assessment, expectation management, and attention to postoperative alignment into perioperative care for AIS patients.</p>

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Patient-perceived recovery after posterior spinal fusion: evaluating minimum clinically important difference (MCID) in adolescents with idiopathic scoliosis

  • 期刊论文

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  • 发表日期：

    2026年5月2日

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  • Leila Mehraban Alvandi ,
  • J. Nicholas Charla,
  • Zachariah Samuel,
  • Edina Gjonbalaj,
  • Mohamed Said,
  • Jorden Xavier,
  • Carolyn Rachofsky,
  • Morgan Roche,
  • Priya Singh,
  • Yungtai Lo,
  • Jacob Schulz,
  • Jaime A. Gomez,
  • Eric D. Fornari

摘要

Background

Adolescent idiopathic scoliosis (AIS) affects 1–3% of children in the United States, with approximately 38,000 patients undergoing posterior spinal fusion (PSF) annually. The relationship between preoperative patient-reported outcomes, postoperative recovery, and long-term clinical significance remains unclear. This study assesses longitudinal changes in Scoliosis Research Society-22r (SRS-22r) scores. It evaluates clinical significance using the Minimum Clinically Important Difference (MCID) in AIS patients undergoing PSF.

Study design

Retrospective study using prospectively collected data.

Methods

A retrospective study was conducted using prospectively collected data on AIS patients who underwent PSF at a single academic institution between 2012 and 2022. Patient-reported outcomes were assessed using the SRS-22r questionnaire at preoperative, 6-month, 1-year, and ≥ 2 years postoperative time points. MCID threshold achievements were determined using anchor-based criteria from Bago et al. The percentage of patients achieving MCID and predictors of MCID achievement were analyzed using logistic regression.

Results

A total of 161 patients (mean age 15.26 ± 2.15 years; 65.8% female) were included. At 1 year, MCID achievement ranged from 30.1% (Self-Image) to 43.4% (Mental Health). By ≥ 2 years, MCID rates declined in Pain (25.9%) and Self-Image (22.8%) but increased in Function/Activity (44.1%). Lower preoperative SRS-22r scores consistently predicted MCID achievement across all domains. A documented mental-health history reduced the likelihood of Pain MCID at 1 year, and larger postoperative Cobb angles independently decreased the odds of achieving Self-Image MCID at both follow-up points. Neighborhood opportunity (Child Opportunity Index) was not associated with outcomes. Sensitivity analyses demonstrated that complete-case ≥ 2 year MCID rates were consistently bounded by best- and worst-case values and closely approximated LOCF estimates, supporting robustness despite attrition.

Conclusion

Meaningful postoperative improvement after PSF varies substantially by SRS-22r domain. Pain and mental-health gains occurred early and stabilized, whereas function demonstrated ongoing recovery, and self-image improved rapidly and remained stable. MCID achievement was most likely in patients with greater preoperative symptom burden, while mental-health history and residual postoperative deformity diminished domain-specific improvements. The stability of MCID patterns across sensitivity analyses reinforces the reliability of long-term findings. These results highlight the importance of incorporating psychological assessment, expectation management, and attention to postoperative alignment into perioperative care for AIS patients.