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Our 13-year-old daughter has scoliosis they call "idiopathic" because we don't know what caused it. She never complains of pain but she is very self-conscious about her appearance. Is this ever a reason to have surgery to straighten her spine if there isn't any pain?
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This is a very good question. Treatment for scoliosis (curvature of the spine) is usually directed toward preventing deformity and minimizing any effects of the condition on daily function and quality of life (QOL).
Quality of life covers a lot of territory including self-confidence, self-esteem, mood, and body image and appearance. So treatment isn't always just for pain, loss of motion, structural deformity, and/or loss of function.
To measure health-related quality of life (HRQOL) in teens and young adults with idiopathic scoliosis, the Scoliosis Research Society (SRS)-22 survey is often used. This tool was first published as a valid, reliable instrument back in the late 1990s. It is a simple and practical way to assess how patients with this particular condition perceive themselves in terms of pain, self-image, and function.
Research has been done to see if this tool can help direct treatment (surgical versus nonsurgical). Results from a recent study showed that the questionnaire is a good tool to use when assessing differences in pain and body image between patients with small versus large spinal curves. It does not sort out differences between the two groups when it comes to measuring effects on function or mental health.
The SRS-22 really does not show differences with small changes in the severity of the spinal curvatures but it is still a good tool for measuring some things (body image and pain between small and large curves). It's easier to use the SRS-22 to identify patients with larger curves who will need surgery but not as effective for smaller (mild to moderate) curves.
Whenever treatment decisions are being made for children with idiopathic scoliosis, it is good to remember that results of treatment may be affected by other factors that are not measured by the SRS-22. This can include socioeconomic status, body mass index as a measure of obesity, self-esteem, self-confidence, and/or mood (depression, anxiety).
In this age group, self-image is often more important than physical pain or loss of motion. When planning treatment, these other behavioral, psychologic, and social health-related qualities are also important. And surgery isn't the only option for this condition. Physical therapy, bracing, and exercise may be helpful in some cases. Most of the time, the severity of the curvature is the deciding factor when someone needs more than conservative (nonoperative) care.
Together with the team of health care professionals involved in your daughter's care (e.g., orthopedic surgeon, physical therapist, neurosurgeon), all of these factors should be evaluated and discussed when making treatment decisions.
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