Psychosocial effects of early-onset scoliosis

Understanding the psychosocial implications of early-onset scoliosis (EOS) and its treatment on patients and their families is critical for their overall health and well-being, as well as the timely evolution of optimal management. To investigate psychosocial outcomes in EOS, clinical and patient reported outcome (PRO) measures have been utilized in research and clinical settings. Instruments to measure psychosocial outcomes in pediatric patients with EOS can be grouped into two categories: a) instruments specifically assessing psychosocial and behavioral measures and (b) instruments evaluating psychosocial domains as part of HRQoL measures. Studies exploring psychosocial and behavioral measures have helped shape the surgical management of EOS by demonstrating the negative psychosocial outcomes associated with repetitive surgeries. Utilizing HRQoL measures such as Early-Onset Scoliosis 24-Item Questionnaire (EOSQ-24), research has demonstrated distinct differences in psychosocial outcomes among different treatment options as well as different patient characteristics and traits. For example, patients with neuromuscular and syndromic etiologies were generally reported to be at lower psychosocial status but demonstrated to have greater improvements after treatments in these outcomes compared to those with idiopathic and congenital etiologies. Some radiographic and clinical parameters such as abnormal spinopelvic parameters or nonambulatory status were reported to have decreased psychosocial outcomes. Nonoperative interventions, which were believed to have little impact on the patient and family, were demonstrated to in fact have significant negative effects on psychosocial outcomes. Although psychosocial outcomes have recently gained attention in the field of EOS research, a significant amount of work remains to be done, especially in the realm of new surgical techniques with appropriate statistical interpretation.