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Investigators from Ireland sought to determine the timing of return to school and preoperative level of physical activity among patients with adolescent idiopathic scoliosis (AIS) following posterior spinal surgery, and to examine which factors related to these outcomes. Participants were eligible if they had a diagnosis of AIS, were treated with a one-stage posterior spine fusion (PSF), and were ambulatory. Data collected from all enrolled participants included sociodemographics, preoperative Cobb angle, co-morbid conditions, hospital length of stay, and intra- and postoperative complications.
Participants or their parents were administered structured questionnaires via telephone every 6 to 8 weeks postoperatively to assess timing of return to school and physical activity. Assessments continued until participants either reported return to these activities or 18 months had elapsed after PSF. Return to a preoperative level of physical activity or better was characterized as: (1) part-time, defined as low-impact, noncontact, noncompetitive physical activity greater than walking; or (2) unrestricted physical activity. The primary outcomes were delayed return to school full-time and unrestricted physical activity, defined as timing in weeks that was >75th percentile for the study sample. Multivariate regression analysis was conducted to determine the independent predictors of delayed return to school full-time and unrestricted physical activity after accounting for potential confounders.
Of 78 eligible patients, 77 were enrolled. The mean age at surgery was 15 years and the mean preoperative Cobb angle was 62.3°. The median length of hospital stay post-PSF was 10 days.
The median time to return to school full-time was 10 weeks, and to unrestricted physical activity was 24 weeks; the 75th percentiles were 16 and 32 weeks, respectively. Factors significantly associated with delayed full-time return to school included a preoperative Cobb angle of >70° (relative risk [RR] = 3.38; P = .008), weight loss >5 kg during the hospital stay (RR = 3.02; P = .012), and minor perioperative respiratory complications (RR = 2.89; P = .024). Delayed return to unrestricted physical activity was predicted by delayed return to part-time physical activity (RR = 4.12; P = .036) and delayed return to school full-time (RR = 5.3; P = .002).
The investigators conclude that their results add to the current knowledge base regarding actual versus anticipated timing of return to short-term functional outcomes in patients with AIS post-PSF.
Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
This is the first study to prospectively determine the actual timing of return to school and sports in patients with AIS following PSF. Current recommendations for return to sports after PSF for AIS vary and often depend on the individual surgeon’s preference, levels of fusion, and specific...
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