INTRODUCTION
Adult degenerative scoliosis is a frequent 3D spinal deformity associated with pain, activity limitations and reduced health-related quality of life. Conservative treatments including exercise therapy, physical activity and spinal bracing are usually offered in the first-line. When conservative treatments have failed, surgery may be considered. The main objective of this study was to compare health-related quality of life between patient receiving conservative and surgical treatments at 2-year follow-up. Secondary objectives were to compare other clinical scores between these 2 groups.
METHODS
We conducted a prospective observational study of adults with lumbar or thoraco-lumbar degenerative scoliosis (Cobb angle ≥ 25°) followed-up for 2 years in 12 French centres. Two groups were defined: conservative group and surgical group. All participants underwent a complete physical and radiological examination, including full spine radiograph (coronal and sagittal). Four clinical scores were reported at 3 timepoints: baseline (corresponding to the time of surgery in the surgical group and start of the follow-up in the conservative group) and 1-year and 2-year follow-up. They included Short Form-12 (SF-12) (health-related quality of life score), pain visual analog scale (VAS), Scoliosis Research Society-30 (SRS-30) (scoliosis-specific activity limitations) and Oswestry Disability Index (ODI, low back pain-specific activity limitations).
RESULTS
Overall, 181 patients met inclusion criteria including 156 women (86%) and 25 men (14%). At 2-year follow-up, SF-12 could be analyzed for 113 participants (88 in the surgical group and 33 in the conservative group. At baseline, participants in the conservative group were older than in the surgical group (74 vs 65 years, respectively). Mean Cobb angle was 48°, with no difference between the 2 groups. There was no difference in SF-12, pain VAS and ODI. SRS-30 was significantly better in the conservative group. At 2-year follow-up, there was a significant improvement in scores for all patients, with no difference between the 2 groups in SF-12 and other clinical scores.
DISCUSSION
In adults with degenerative scoliosis, both conservative and surgical treatments are associated with an improvement in health-related quality of life and clinical scores at 2 years. All participants were satisfied with their treatment.