Sex-Based Differences in Psychosocial Recovery Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Abstract

Background: Although posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) reliably improves radiographic alignment, radiological correction alone does not necessarily reflect postoperative recovery, particularly in terms of psychosocial well-being. Patient-reported outcome measures (PROMs) have become central to outcome assessment in AIS; however, the relative contributions of disease-specific and generic instruments, sex-based differences, and functional recovery, including return to sports, remain unclear. Methods: This prospective single-center cohort study encompassed adolescents aged 13–18 years who underwent PSF for AIS between December 2020 and November 2023. All included patients had a minimum postoperative follow-up of 24 months at the time of analysis. Health-related quality of life (HRQoL) was evaluated preoperatively and at least 2 years postoperatively using the Scoliosis Research Society–22 revised questionnaire (SRS-22r) and the Pediatric Quality of Life Inventory (PedsQL) Teen Report (ages 13–18 years). Outcomes were compared between male and female patients. Return to the preoperative level of sports was evaluated as a functional outcome. Results: Overall, 108 adolescents with AIS (32 males, 76 females) were included. Male patients were slightly older at the time of surgery, whereas baseline radiographic characteristics, treatment patterns, and follow-up duration were comparable between sexes. At preoperative assessment, male patients reported higher SRS-22r self-image and mental health scores compared with female patients (both p < 0.001). These differences were no longer present at the last follow-up (all p > 0.05). Emotional functioning improved significantly in both sexes (p < 0.001), whereas changes in pain and physical function were limited. The total PedsQL score increased significantly in female patients but not in males (p = 0.521). Patients across all Lenke curve types demonstrated postoperative improvements. Those with Lenke type 1 exhibited higher mean changes in SRS-22r and PedsQL total scores; however, differences in change scores between Lenke types demonstrated no statistical significance. At final follow-up, 93.5% of patients had not returned to their preoperative level of physical activity. Conclusions: PSF for AIS was associated with domain-specific improvements in HRQoL, predominantly reflecting psychosocial domains rather than changes in pain or physical function. Preoperative sex-based differences resolve postoperatively, and patients with Lenke curve types demonstrate improvements, with a tendency toward greater gains in Lenke type 1. Despite these improvements, return to preoperative sport levels remains restricted, indicating a gap between patient-reported recovery and functional reintegration.