Comparative long-term quality of life outcomes in adolescent idiopathic scoliosis: a meta-analysis of surgical, conservative, and observation-based strategies.
Jesús Burgos, Eduardo Hevia, Vicente García et al.
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In 30 seconds
This systematic review and meta-analysis compared long-term health-related quality of life (HRQoL) in people with adolescent idiopathic scoliosis managed with surgery, bracing, or observation. Eight studies with at least ten years of follow-up were reviewed, and six contributed to the meta-analysis. Compared with surgery, observation was associated with better functional outcomes (MD 0.43, 95% CI 0.01-0.84) and mental health outcomes (MD 0.12, 95% CI 0.03-0.20); pain, self-image, and satisfaction did not differ significantly. Observation and bracing showed equivalent outcomes across all assessed domains. Evidence certainty was moderate to low.
Key findings
- Observation was associated with better function than surgery (MD 0.43, 95% CI 0.01-0.84).
- Observation was associated with better mental health than surgery (MD 0.12, 95% CI 0.03-0.20).
- Pain, self-image, and satisfaction did not differ significantly between observation and surgery.
- Observation and bracing showed equivalent outcomes across all assessed HRQoL domains.
Why it matters
The findings suggest that long-term quality of life does not necessarily favor active intervention over observation in adolescent idiopathic scoliosis. They help frame discussions of treatment outcomes beyond curve management, while the moderate-to-low certainty of evidence means comparisons should be interpreted cautiously and individualized care remains important.
What to keep in mind
The evidence came from eight studies, with six included in the meta-analysis, and certainty ranged from moderate to low; the abstract calls for further high-quality research.