Self-image outcomes and pre surgical radiographic, pain, and mental health measures predicting post-surgical satisfaction among adolescents with idiopathic scoliosis undergoing spinal fusion surgery
Manalo, Gem Marian
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OBJECTIVE: The overall goal of this study was to examine the relationship between preoperative, 1-year post-operative, and 2-year postoperative self-image in adolescents with idiopathic scoliosis undergoing spinal fusion surgery. In addition, a minor goal was to examine the relationship between pre-surgical mental health and post-surgical self-image and satisfaction. Additionally, spinal curvature and preoperative pain were explored in relation to the effect of pre-surgical mental health on post-surgical self-image. Analyses were performed in order to better understand the relationship of corrective surgery to self-image, and self-image's relationship to persistent postoperative pain, which has been recognized as a common clinically significant problem. METHODS: The Scoliosis Research Society Questionnaire-30 and Spinal Appearance Questionnaire were administered to 219 patients enrolled in the Prospective Pediatric Scoliosis study at pre-operative, 1-year post-operative, and 2-year post-operative time points. A subset (n=163) of these patients had complete data. The Scoliosis Research Society Questionnaire-30 includes pain and mental health subscales, which were examined preoperatively for the purpose of this study. Measurements of preoperative curve (Cobb) angle percentage correction were used in the analysis of this data, which were determined using operative notes. The Spinal Appearance Questionnaire (SAQ) includes self-image appearance and expectations subscales, which were examined at the preoperative, 1-year postoperative, and 2-year postoperative time points. RESULTS: There were significant improvements in self-image after surgical intervention in children with idiopathic scoliosis undergoing spinal fusion surgery. Cobb angle percentage correction, preoperative pain scores as determined by the SRS-30, and preoperative mental health scores as determined by the SRS-30 were not significant predictors of postoperative self-image as measured by the SAQ. There is little to no correlation between the preoperative measures and postoperative self-image. CONCLUSIONS: Prior studies have confirmed that pediatric persistent postsurgical pain is a significant health concern, and that presurgical mental health and self-image are factors that contribute to a pediatric patient's longitudinal experience with postsurgical pain. This study shows that there are clinically significant improvements in self-image after surgical intervention in patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery. These findings suggest that preoperative pain, degree of spinal curvature correction, and preoperative mental health are not determinative of postoperative self-image in pediatric populations. Future studies should be conducted on more diverse populations, and take into account measures that may be predictors of poor postoperative self-image, specifically depression and anxiety. In summary it is important to explore the biological mechanisms pertaining to pediatric post-surgical chronic pain and their relation to differences in somatosensory phenotypes in this patient population.