Responsiveness of trunk asymmetry measurements in clinical photographs after adolescent idiopathic scoliosis surgery.

Objective: To evaluate the correlation between changes in body image perception and trunk asymmetry measured in clinical photographs after adolescent idiopathic scoliosis (AIS) surgical treatment.

Methods: This is a prospective study of patients operated on for AIS with Lenke curves 1 and 2. Preoperatively and one year after surgery, patients underwent full-spine X-rays and digital photographs. They also completed the SRS-22R and Trunk Appearance Perception Scale (TAPS) questionnaires. On X-rays, the coronal Cobb angle was measured. In back torso photographs, the shoulder (SHA), axillary (AHA), and waist (WHA) height angles, waist fold angle (WA-r and WA-I), and the right/left ratio of hemitrunks (ArT) were measured. The pre- and post-surgery mean differences for all variables were calculated. The correlation between the improvement in the photographic variables and the questionnaire scores was also analyzed.

Results: 52 patients (82.7% female; mean age 15.6 years, mean preoperative Cobb 65.8°) were included. Significant differences were found between pre and postoperative mean scores in all variables. No correlation was found between the change in trunk asymmetry photographic parameters and the change in SRS-22/ TAPS imaging scale scores.

Conclusions: Surgery for idiopathic scoliosis significantly improves radiological deformity, trunk asymmetry, perception of trunk deformity, and body image. Photographic measures show significant responsiveness after surgery. The effect size of the change in photographic parameters was similar to that observed in the SRS-22 questionnaire and less than the radiological. However, no relationship was found between the changes observed in patient reported, radiological and photographic measures.