Surgical Versus Non-Surgical Treatment of Patients with Myopathic Scoliosis: Clinical, Radiological and Functional Outcomes

TL;DR

Surgical treatment for myopathic scoliosis does not prevent spinal deformity worsening over time but may improve quality of life and functional independence.

Contribution

This study compares surgical and non-surgical outcomes in myopathic scoliosis, emphasizing patient-centered quality of life and functional outcomes.

Findings

Both surgical and non-surgical groups showed similar worsening of spinal deformity over time.

Surgically treated patients reported higher quality of life and functional independence, especially in self-image domains.

Surgical correction may enhance subjective well-being despite limited objective spinal improvement.

Abstract

What are the main findings?
•In patients with myopathic scoliosis, both surgical and non-surgical groups showed similar worsening spinal deformity over time.•Despite similar radiological outcomes, surgically treated patients reported higher overall quality of life and functional independence, particularly in self-image domains.

In patients with myopathic scoliosis, both surgical and non-surgical groups showed similar worsening spinal deformity over time.

Despite similar radiological outcomes, surgically treated patients reported higher overall quality of life and functional independence, particularly in self-image domains.

What are the implications of the main findings?
•Surgical correction may enhance subjective quality of life even when objective spinal improvement is limited, emphasizing the importance of patient-centered outcomes.•Decision-making for scoliosis surgery in myopathic patients should carefully balance medical risks with potential long-term gains in function and well-being.

Surgical correction may enhance subjective quality of life even when objective spinal improvement is limited, emphasizing the importance of patient-centered outcomes.

Decision-making for scoliosis surgery in myopathic patients should carefully balance medical risks with potential long-term gains in function and well-being.

Background/Objectives: Myopathies are acquired or genetic muscle diseases causing weakness and wasting, leading to poor posture, impaired coordination, reduced daily function, and scoliosis. The objective of this ambispective study was to compare clinical, radiological, and functional outcomes of patients with myopathic scoliosis treated surgically or non-surgically. Methods: We identified 118 patients (55% male) with myopathy and scoliosis from ALYN Rehabilitation Hospital’s database (1990–2022). Mean age at first visit was 5.45 ± 5.27 years. Seventeen (14%) underwent scoliosis surgery; others were managed non-surgically. Due to unbalanced group sizes, comparative group analyses used propensity score matching (15 surgical, 30 non-surgical patients). Retrospective data included demographics, medical history, respiratory and mobility status, Cobb angle (CA), pelvic obliquity (PO), and surgical details when applicable. Prospective telephone interviews were conducted including SRS-22r Quality of Life (QoL), WHO-QoL, and Functional Independence Measure for Children (WeeFIM). Results: Longitudinal analysis showed significant or near-significant worsening over time in CA (p = 0.03) and PO (p = 0.08), regardless of treatment type but no significant difference between surgical and non-surgical groups in progression rates. Interview data, for 7 surgical and 6 non-surgical patients, revealed that surgical patients reported higher overall QoL, FIM, and SRS-22r self-image scores, but lower scores for SRS-22r pain, general function, and activity levels. Conclusions: Existing research and this study suggest that despite surgical risks, scoliosis correction in neuromuscular conditions generally leads to improved QoL. Findings highlight the complexity of surgical decision-making for myopathic scoliosis, where medical risks must be weighed against potential long-term functional and QoL outcomes.

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