A New Radiologic Parameter for Optimizing the Cosmetic Perception and Postoperative Satisfaction of Scoliosis: Preoperative Skin Curve Length/Bone Curve Length Ratio

Objective: Sometimes, curvatures with higher Cobb angles may not affect the cosmetic appearance as much as some lower Cobb angle scoliosis. Mostly, admissions to hospitals in adolescent idiopathic scoliosis are for subjective cosmetic reasons. Postoperative satisfaction may be insufficient despite high radiographic correction. Converting perception to objective numerical values may be useful. We evaluated the skin curve length/bone curve length ratio on preoperative and postoperative second-year Scoliosis Research Society questionnaire-22 revised (SRS-22r) scores to present an objective assessment of perception and guide satisfaction concerns.

Methods: Forty female, posteriorly instrumented Lenke type 1 adolescent idiopathic scoliosis patients were grouped according to change in SRS-22r total scores compared to preoperative total scores as group 1 (lower postoperative second-year scores), group 2 (0-4 points higher), and group 3 (≥5 points higher postoperative second-year scores) and also in the second step according to change in SRS-22r self-image scores compared to preoperative scores: group self-image-minus (lower postoperative second-year scores), group self-image-0 (same scores), and group self-image-plus (higher postoperative second-year scores). The relationships between postoperative satisfaction and preoperati ve/postoperative second-year Cobb angle, apical vertebral translation, coronal balance, thoracic truncal shift, thoracic kyphosis, lumbar lordosis, sagittal balance, skin curve length/bone curve length, and preoperative SRS-22r domains were evaluated.

Results: No significant difference between groups in preoperative skin curve length, preoperative bone curve length, age, Risser stage, follow-up time, instrumentation levels, preoperative and postoperative second-year Cobb angle, coronal balance, apical vertebral translation, thoracic truncal shift, thoracic kyphosis, lumbar lordosis, and sagittal balance (P > .05) was detected. Significant difference between group 1 and group 2 (P=.014) and group 1 and group 3 in preoperative skin curve length/bone curve length was detected (P=.009). Significant difference in preoperative skin curve length/bone curve length between group SI-Minus and Group SI-Plus was detected. A negative correlation between satisfaction and postoperative secondyear thoracic truncal shift (r: –0.244, P=.016) and preoperative skin curve length/bone curve length (r: –0.263, P = .035) and a positive correlation between postoperative second-year satisfaction and postoperative second-year skin curve length/bone curve length (r: 0.201, P=.047) were detected. A negative correlation between preoperative total score and preoperative Cobb angle (r: –0.218, P=.031) was detected.

Conclusions: Using preoperative skin curve length/bone curve length is a simple, inexpensive method that allows predicting changes in satisfaction and SI scores. So, expectations of patients and surgeons can be rationalized; future concerns or disagreements between patients and doctors can be avoided.

Cite this article as: Albay C, Kaygusuz MA, Kargın D, Öner A. A new radiologic parameter for optimizing the cosmetic perception and postoperative satisfaction of scoliosis: Preoperative skin curve length/bone curve length ratio. Arch Basic Clin Res 2022;4(3):96-105.